Follow-up of the 105 patients who did not undergo initial imaging revealed that 10/105 (9.5%) of the patients were readmitted the following year with urosepsis; of these patients, imaging by US or CT was indicated for 6/10, and a major abnormality was detected in 3/6 imaged patients. Hoddick et al [13] performed a prospective study of 12 patients with urosepsis who were evaluated with both US and CT. Of these, 6/12 patients had renal abscesses, of whom 6/6 (100%) of the patients were identified on both US and contrast-enhanced CT. One patient had multiple perirenal abscesses, and another patient had a gas-forming perinephric abscess that were both missed by US but seen on CT. WBC Scan Abdomen and Pelvis There are no data to support the use of WBC scan abdomen and pelvis as an initial diagnostic imaging study in the diagnosis of sepsis. Variant 5: Suspected or confirmed sepsis. No specific symptoms suggestive of origin, or symptoms cannot be assessed. Normal or equivocal or nonspecific chest radiograph. Next imaging study. CT plays an important role in the evaluation of patients with suspected sepsis because of its high PPV [6] when performed as either an initial or follow-up imaging study, which often leads to a change in management [7]. Septic foci are most commonly detected in the chest, abdomen, or pelvis. Of note, transthoracic echocardiography, which plays an important role in the diagnosis of infective endocarditis and associated sepsis, is not addressed in this appropriateness criteria owing to the scope of the topic and that this imaging examination is typically performed outside of radiology. CT Abdomen and Pelvis With IV Contrast Pohlan et al [6] in a retrospective study of 357 ED patients with suspected sepsis, of whom 132 underwent CT scan within 72 hours of admission, 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).
Sepsis. Follow-up of the 105 patients who did not undergo initial imaging revealed that 10/105 (9.5%) of the patients were readmitted the following year with urosepsis; of these patients, imaging by US or CT was indicated for 6/10, and a major abnormality was detected in 3/6 imaged patients. Hoddick et al [13] performed a prospective study of 12 patients with urosepsis who were evaluated with both US and CT. Of these, 6/12 patients had renal abscesses, of whom 6/6 (100%) of the patients were identified on both US and contrast-enhanced CT. One patient had multiple perirenal abscesses, and another patient had a gas-forming perinephric abscess that were both missed by US but seen on CT. WBC Scan Abdomen and Pelvis There are no data to support the use of WBC scan abdomen and pelvis as an initial diagnostic imaging study in the diagnosis of sepsis. Variant 5: Suspected or confirmed sepsis. No specific symptoms suggestive of origin, or symptoms cannot be assessed. Normal or equivocal or nonspecific chest radiograph. Next imaging study. CT plays an important role in the evaluation of patients with suspected sepsis because of its high PPV [6] when performed as either an initial or follow-up imaging study, which often leads to a change in management [7]. Septic foci are most commonly detected in the chest, abdomen, or pelvis. Of note, transthoracic echocardiography, which plays an important role in the diagnosis of infective endocarditis and associated sepsis, is not addressed in this appropriateness criteria owing to the scope of the topic and that this imaging examination is typically performed outside of radiology. CT Abdomen and Pelvis With IV Contrast Pohlan et al [6] in a retrospective study of 357 ED patients with suspected sepsis, of whom 132 underwent CT scan within 72 hours of admission, 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).