by Heiner Nebelung,
Natalie Wotschel, Hanns-Christoph Held, Johanna Kirchberg, Jürgen Weitz,
Christoph Georg Radosa, Michael Laniado, Ralf-Thorsten Hoffmann and Verena
Plodeck
Annals of
Intensive Care volume 13,
Article number: 6 (2023)
Background
The aim of this study was to assess the usefulness of adding
thoracic CT to abdominal CT in intensive care unit (ICU) patients with signs of
infection after abdominopelvic surgery.
Methods
143 thoracoabdominal CTs of ICU patients with signs of
infection after abdominopelvic surgery were retrospectively reviewed for
thoracic pathologies. It was determined if pathologic findings were visible
only on thoracic CT above the diaphragmatic dome or also on abdominal CT up to
the diaphragmatic dome. All thoracic pathologies visible only above the
diaphragmatic dome were retrospectively analyzed by an ICU physician in terms
of clinical relevance. Diagnostic and therapeutic efficacy of thoracic CT were
assessed with regard to an infectious focus and to other pathologic findings.
Results
297 pathologic thoracic findings were recorded. 26 of the
297 findings could only be detected on images obtained above the diaphragmatic
dome (in 23 of 143 CTs). A change in patient management was initiated due to
only one of the 26 supradiaphragmatic findings. Diagnostic efficacy of thoracic
CT in addition to abdominal CT to identify an infectious focus was 3.5%
(95%-CI: 0.5–6.5%) and therapeutic efficacy was 0.7% (95%-CI: 0–2.1%). With
regard to all pathologic thoracic findings, diagnostic efficacy was 16.1%
(95%-CI: 10.1–22.1%) and therapeutic efficacy remained at 0.7%.
Conclusions
Additional thoracic CT to detect an infectious focus in ICU
patients after abdominopelvic surgery leads to identification of the focus in
only 3.5% and to changes in patient management in only 0.7%. Other relevant
findings are more common (16.1%), but very rarely affect patient management.
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