Computed tomography in patients with sepsis presenting to the emergency department: exploring its role in light of patient outcomes

Julian Pohlan; Martin Möckel; Anna Slagman; Hannah Tenenbaum; Jules Stolz; Kerstin Rubarth; Johannes Winning; Michael Bauer; Konrad Reinhart; Angelika Stacke; Marc Dewey; Myrto Bolanaki

doi:10.1007/s00330-024-10701-y

Computed tomography in patients with sepsis presenting to the emergency department: exploring its role in light of patient outcomes

Eur Radiol. 2024 Apr 9. doi: 10.1007/s00330-024-10701-y. Online ahead of print.

Authors

Julian Pohlan^{1

2}, Martin Möckel³, Anna Slagman³, Hannah Tenenbaum¹, Jules Stolz¹, Kerstin Rubarth^{2

4}, Johannes Winning⁵, Michael Bauer⁵, Konrad Reinhart⁶, Angelika Stacke⁷, Marc Dewey¹, Myrto Bolanaki⁸

Affiliations

¹ Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
² Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
³ Department of Emergency and Acute Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
⁴ Institute for Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
⁵ Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
⁶ Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
⁷ Ernst-Abbe-Hochschule, University of Applied Sciences, Carl-Zeiss-Promenade 2, 07745, Jena, Germany.
⁸ Department of Emergency and Acute Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. myrto.bolanaki@charite.de.

PMID: 38592420
DOI: 10.1007/s00330-024-10701-y

Abstract

Objectives: This study aimed to explore the role of CT in septic patients presenting to the emergency department (ED).

Materials and methods: We performed a retrospective secondary analysis of 192 septic patients from a prospective observational study, i.e., the "LIFE POC" study. Sepsis was diagnosed in accordance with the Sepsis-3 definition. Clinical and radiological data were collected from the hospital administration and radiological systems. Information on mortality and morbidity was collected. Time-to-CT between CT scan and sepsis diagnosis (ttCTsd) was calculated. Diagnostic accuracy was assessed with the final sepsis source as reference standard. The reference standard was established through the treating team of the patient based on all available clinical, imaging, and microbiological data.

Results: Sixty-two of 192 patients underwent a CT examination for sepsis focus detection. The final septic source was identified by CT in 69.4% (n = 43). CT detected septic foci with 81.1% sensitivity (95% CI, 68.0-90.6%) and 55.6% specificity (95% CI, 21.2-86.3%). Patients with short versus long ttCTsd did not differ in terms of mortality (16.1%, n = 5 vs 9.7, n = 3; p = 0.449), length of hospital stay (median 16 d, IQR 9 d 12 h-23 d 18 h vs median 13 d, IQR 10 d 00 h-24 d 00 h; p = 0.863), or duration of intensive care (median 3d 12 h, IQR 2 d 6 h-7 d 18 h vs median 5d, IQR 2 d-11 d; p = 0.800).

Conclusions: Our findings show a high sensitivity of CT in ED patients with sepsis, confirming its relevance in guiding treatment decisions. The low specificity suggests that a negative CT requires further ancillary diagnostic tests for focus detection. The timing of CT did not affect morbidity or mortality outcomes.

Clinical relevance statement: In patients with sepsis who present to the ED, CT can be used to identify infectious foci on the basis of clinical suspicion, but should not be used as a rule-out test. Scientific evidence for the optimal timing of CT beyond clinical decision-making is currently missing, as potential mortality benefits are clouded by differences in clinical severity at the time of ED presentation.

Key points: • In patients with sepsis who present to the ED, CT for focus identification has a high sensitivity and can thereby be valuable for patient management. • As the specificity is considerably lower, a thorough microbiological assessment is important in these cases. • The timing of CT did not affect morbidity and mortality outcomes in this study, which might be due to variability in clinical severity at the time of ED presentation.

Keywords: CT; Diagnostic accuracy; Emergency department; Mortality; Sepsis.