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] performed 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). 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 and/or abdomen 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 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 such as abdominal radiography were not recorded.
Sepsis. 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] performed 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). 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 and/or abdomen 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 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 such as abdominal radiography were not recorded.