The most commonly identified source of infection, which the authors refer to as septic foci, was in the chest (pneumonia) reported in 38.6% (49/127) of patients. The second and third most commonly identified septic foci were in the abdomen, 22.0% (28/127 patients), and pelvis/genitourinary tract, 20.5% (26/127 patients). A PPV of 81.82% (CI, 76.31%-86.28%) was calculated for septic foci identified by CT. However, the NPV was only 21.74% (CI, 10.73%-39.11%). Patients with suspected sepsis who received a CT within 72 hours of admission were given a final diagnosis of sepsis in 93.3% of cases (124/132). The detection of septic foci in 76.5% of CTs results in a high diagnostic yield for CT in septic ED patients, particularly in patients who are extremely ill and/or require ICU admission. Just et al [7] performed a single-center 1 year retrospective study of all CT scans of the chest, abdomen, or both ordered in pursuit of suspected infection in surgical ICU patients. A source of infection was found in 76/144 of cases (52.8%) and resulted in a change of management in 65/144 (45%) of patients, including a change in antimicrobial regimen, surgery, and nonsurgical interventions such as placement of drainage catheters. A pathologic infectious source was found in the chest in 72% of patients who underwent chest CT. A pathologic infectious source was found in up to 44% of patients who underwent abdominal CT (exact breakdown not provided). Use of IV contrast was not specified in this study. Furthermore, preceding diagnostic procedures including chest radiography were not recorded. CT Chest, Abdomen, and Pelvis Without and With IV Contrast There are no data to support the use of any added value of a CT chest, abdomen, and pelvis without IV contrast immediately before acquisition of a contrast-enhanced CT in the diagnosis of sepsis.
Sepsis. The most commonly identified source of infection, which the authors refer to as septic foci, was in the chest (pneumonia) reported in 38.6% (49/127) of patients. The second and third most commonly identified septic foci were in the abdomen, 22.0% (28/127 patients), and pelvis/genitourinary tract, 20.5% (26/127 patients). A PPV of 81.82% (CI, 76.31%-86.28%) was calculated for septic foci identified by CT. However, the NPV was only 21.74% (CI, 10.73%-39.11%). Patients with suspected sepsis who received a CT within 72 hours of admission were given a final diagnosis of sepsis in 93.3% of cases (124/132). The detection of septic foci in 76.5% of CTs results in a high diagnostic yield for CT in septic ED patients, particularly in patients who are extremely ill and/or require ICU admission. Just et al [7] performed a single-center 1 year retrospective study of all CT scans of the chest, abdomen, or both ordered in pursuit of suspected infection in surgical ICU patients. A source of infection was found in 76/144 of cases (52.8%) and resulted in a change of management in 65/144 (45%) of patients, including a change in antimicrobial regimen, surgery, and nonsurgical interventions such as placement of drainage catheters. A pathologic infectious source was found in the chest in 72% of patients who underwent chest CT. A pathologic infectious source was found in up to 44% of patients who underwent abdominal CT (exact breakdown not provided). Use of IV contrast was not specified in this study. Furthermore, preceding diagnostic procedures including chest radiography were not recorded. CT Chest, Abdomen, and Pelvis Without and With IV Contrast There are no data to support the use of any added value of a CT chest, abdomen, and pelvis without IV contrast immediately before acquisition of a contrast-enhanced CT in the diagnosis of sepsis.