Community-acquired Pneumonia Visualized on Computed Tomography but Not Chest X-Ray: Pathogens, Severity, and Clinical Outcomes.

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Community-acquired Pneumonia Visualized on Computed Tomography but Not Chest X-Ray: Pathogens, Severity, and Clinical Outcomes.

Chest. 2017 Aug 09;:

Authors: Upchurch CP, Grijalva CG, Wunderink RG, Williams DJ, Waterer GW, Anderson EJ, Zhu Y, Hart EM, Carroll F, Bramley AM, Jain S, Edwards KM, Self WH

Abstract
BACKGROUND: The clinical significance of pneumonia visualized on computed tomography (CT) in the setting of a normal chest x-ray (CXR) is uncertain.
METHODS: In a multicenter prospective surveillance study of adults hospitalized with community-acquired pneumonia (CAP), we compared the presenting clinical features, pathogens, and outcomes of patients with pneumonia visualized on CT but not on concurrent CXR (CT-only pneumonia) and those with pneumonia visualized on CXR. All patients underwent CXR; the decision to obtain CT imaging was determined by the treating clinicians. CXR and CT images were interpreted by study-dedicated thoracic radiologists blinded to clinical data.
RESULTS: The study population included 2,251 adults with CAP; 2,185 (97%) patients had pneumonia visualized on CXR while 66 (3%) had pneumonia visualized on CT but not concurrent CXR. Overall, these patients with CT-only pneumonia had a similar clinical profile to those with pneumonia visualized on CXR, including comorbidities, vital signs, hospital length of stay, prevalence of viral (30% vs 26%) and bacterial pathogens (12% vs 14%), intensive care unit admission (23% vs 21%), mechanical ventilation (6% vs 5%), septic shock (5% vs 4%), and in-hospital mortality (0 vs 2%).
CONCLUSIONS: Adults hospitalized with CAP who had radiologic evidence of pneumonia on CT but not concurrent CXR had similar pathogens, disease severity, and outcomes compared with patients who had signs of pneumonia on CXR. These findings support using of the same management principles for patients with CT-only pneumonia as those with pneumonia on CXR.

PMID: 28802696 [PubMed - as supplied by publisher]

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