Dataset Information

Usefulness of computed tomography for hospitalized adult patients with fever to investigate cause of fever: single-center, retrospective cohort study.

ABSTRACT:

Purpose

To verify that physicians' presumptive diagnosis is the most significant factor for finding any signs related to the cause of fever on computed tomography (CT) images.

Materials and methods

This single-center retrospective cohort study included patients (age ≥ 16 years) who underwent CT to investigate the cause of fever between January 1, 2014, and August 31, 2016. Patients who underwent surgical procedures were excluded. The primary outcome was the presence of suspicious CT findings related to the cause of fever. We performed univariate and multivariate logistic regression analyses, adjusted for CT contrast agent use, quick sequential organ failure assessment score > 1, and C-reactive protein level.

Results

We enrolled 171 patients, of which 57 had CT findings, and 114 did not. Multivariate logistic regression analyses demonstrated a significant difference for the presence of a presumptive diagnosis by the attending physician (odds ratio, 4.99; 95% confidence interval 2.31-10.76; p < 0.01), but not for other covariates, including C-reactive protein.

Conclusions

In hospitalized patients with fever, an attending physicians' presumptive diagnosis is associated with the presence of fever-related CT findings. Improving the quality of the diagnostic assessment before the CT scan may lead to more appropriate CT imaging use.

SUBMITTER: Hamabe F

PROVIDER: S-EPMC8088207 | biostudies-literature | 2021 Aug

REPOSITORIES: biostudies-literature

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Publications

Usefulness of computed tomography for hospitalized adult patients with fever to investigate cause of fever: single-center, retrospective cohort study.

Hamabe Fumiko F Terayama Takero T Mikoshi Ayako A Murakami Wakana W Yamada Kohei K Soga Shigeyoshi S Shinmoto Hiroshi H

Japanese journal of radiology 20210501 8

<h4>Purpose</h4>To verify that physicians' presumptive diagnosis is the most significant factor for finding any signs related to the cause of fever on computed tomography (CT) images.<h4>Materials and methods</h4>This single-center retrospective cohort study included patients (age ≥ 16 years) who underwent CT to investigate the cause of fever between January 1, 2014, and August 31, 2016. Patients who underwent surgical procedures were excluded. The primary outcome was the presence of suspicious ...[more]

PMID: 33932188

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Project description:BackgroundLiterature has suggested that imaging is over-utilized in the diagnosis of pancreatitis. If the diagnosis of acute pancreatitis (AP) is established with abdominal pain and increased serum amylase or lipase activity without systemic signs of severe disease, computed tomography (CT) imaging may not be necessary. We hypothesize that among patients with uncomplicated acute pancreatitis (AUP), there is a significant number of unwarranted CT imaging studies. This imposes increased expenditure and cost in our healthcare system and does not improve hospital stay or management of AUP.AimTo assess the overutilization and associated cost of CT imaging among patients meeting diagnostic criteria for AUP.MethodsIn this Institutional Review Board-approved retrospective, single-center study, we identified all adult patients admitted with AP from January 1, 2012 through October 1, 2017. Patients were identified via International Classification of Diseases (ICD-9) code for AP (577.0) and ICD-10 codes for different etiological AP (K85.9 unspecified, K85.0 idiopathic, K85.1 biliary, K85.2 alcohol-induced, K85.3 drug-induced, and K85.8 other). Diagnosis was confirmed by chart review using established non-imaging diagnostic criteria (presence of typical abdominal pain and elevated lipase or amylase greater than 3 times upper limit of normal). Ranson criteria and BISAP scores on presentation were calculated and patients that met scores less than or equal to 2 for both were included to suggest AUP. The utilization and cost of imaging in these patients were recorded.ResultsBetween January 2012 and October 2017, 1305 patients presented to the emergency department with AP, and 405 patients (31%) met our inclusion criteria for AUP (201 males, 204 females; mean age 49 years, range 18-98). Of those, 210 patients (51.85%) underwent CT imaging. One patient (0.47%) had evidence of pancreatic necrosis, one patient had cyst formation (0.47%), and the remaining 208 patients (99.05%) had either normal CT scan imaging or findings consistent with mild AP without necrosis. The average cost of CT scan imaging was $4510 with a total cost of $947056. Median length of hospitalization stay was 3 d among both groups. Combining Ranson's Criteria and BISAP score identified AUP in our patient population with an accuracy of 99.5%.ConclusionCT imaging is unnecessary when AUP is diagnosed clinically and biochemically. Reducing overuse of diagnostic CT scans will decrease healthcare expenditure and radiation exposure to patients.

Project description:Consistent pixel sizes are of fundamental importance for assessing texture features that relate intensity and spatial information in radiomics studies. To correct for the effects of variable pixel sizes, we combined image resampling with Butterworth filtering in the frequency domain and tested the correction on computed tomography (CT) scans of lung cancer patients reconstructed 5 times with pixel sizes varying from 0.59 to 0.98 mm. One hundred fifty radiomics features were calculated for each preprocessing and field-of-view combination. Intra-patient agreement and inter-patient agreement were compared using the overall concordance correlation coefficient (OCCC). To further evaluate the corrections, hierarchical clustering was used to identify patient scans before and after correction. To assess the general applicability of the corrections, they were applied to 17 CT scans of a radiomics phantom. The reduction in the inter-scanner variability relative to non-small cell lung cancer patient scans was quantified. The variation in pixel sizes caused the intra-patient variability to be large (OCCC <95%) relative to the inter-patient variability in 79% of the features. However, with the resampling and filtering corrections, the intra-patient variability was relatively large in only 10% of the features. With the filtering correction, 8 of 8 patients were correctly clustered, in contrast to only 2 of 8 without the correction. In the phantom study, resampling and filtering the images of a rubber particle cartridge substantially reduced variability in 61% of the radiomics features and substantially increased variability in only 6% of the features. Surprisingly, resampling without filtering tended to increase the variability. In conclusion, applying a correction based on resampling and Butterworth low-pass filtering in the frequency domain effectively reduced variability in CT radiomics features caused by variations in pixel size. This correction may also reduce the variability introduced by other CT scan acquisition parameters.

Dataset Information

Usefulness of computed tomography for hospitalized adult patients with fever to investigate cause of fever: single-center, retrospective cohort study.

Purpose

Materials and methods

Results

Conclusions

Publications

Usefulness of computed tomography for hospitalized adult patients with fever to investigate cause of fever: single-center, retrospective cohort study.

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