Utility of Computed Tomography in a Differential Diagnosis for the Patients with an Initial Diagnosis of Chronic Obstructive Pulmonary Disease Exacerbation

다국어 초록 (Multilingual Abstract)

Background: The utility of computed tomography (CT) in the differential diagnosis of patients with chronic obstructive pulmonary disease (COPD) exacerbation remains uncertain. However, due to the low cost associated with CT scan along with the impact of Koreas’ health insurance system, there has been a rise in the number of CT scans in the patients with initial diagnosis of COPD exacerbations. Therefore, the utility of CT in the differential diagnosis was investigated to determine whether performing CT scans affect the clinical outcomes of the patients with an initial diagnosis of COPD exacerbation.
Methods: This study involved 202 COPD patients hospitalized with an initial diagnosis of COPD exacerbation. We evaluated the change in diagnosis or treatment after performing a CT scan, and compared the clinical outcomes of patient groups with vs. without performing CT (non-CT group vs. CT group).
Results: After performing CT, the diagnosis was changed for two (3.0%) while additional diagnoses were made for 27 of the 64 patients (42.1%). However, the treatment changed for only one (1.5%), and six patients (9.3%) received supplementary medication. There were no difference in the median length of hospital stay (8 [6–13] days vs. 8 [6–12] days, p=0.786) and intensive care unit care (14 [10.1%] vs. 11 [16.7%], p=0.236) between the CT and non-CT groups, respectively. These findings remained consistent even after the propensity score matching.
Conclusion: Utility of CT in patients with acute COPD exacerbation might not be helpful; therefore, we do not recommend chest CT scan as a routine initial diagnostic tool.

참고문헌 (Reference)

1 Nagarsheth K, "Ultrasound detection of pneumothorax compared with chest X-ray and computed tomography scan" 77 : 480-484, 2011

2 Shapira-Rootman M, "The prevalence of pulmonary embolism among patients suffering from acute exacerbations of chronic obstructive pulmonary disease" 22 : 257-260, 2015

3 Akpinar EE, "Should the cut-off value of D-dimer be elevated to exclude pulmonary embolism in acute exacerbation of COPD?" 5 : 430-434, 2013

4 Rutschmann OT, "Should pulmonary embolism be suspected in exacerbation of chronic obstructive pulmonary disease?" 62 : 121-125, 2007

5 Hackx M, "Severe COPD exacerbation : CT features" 12 : 38-45, 2015

6 Soltani A, "Prospective outcomes in patients with acute exacerbations of chronic obstructive pulmonary disease presenting to hospital: a generalisable clinical audit" 45 : 925-933, 2015

7 Rizkallah J, "Prevalence of pulmonary embolism in acute exacerbations of COPD : a systematic review and metaanalysis" 135 : 786-793, 2009

8 Choi KJ, "Prevalence and predictors of pulmonary embolism in Korean patients with exacerbation of chronic obstructive pulmonary disease" 85 : 203-209, 2013

9 Diamantea F, "Prediction of hospitalization stay in COPD exacerbations : the AECOPD-F score" 59 : 1679-1686, 2014

10 Ramaraju K, "Predicting healthcare utilization by patients admitted for COPD exacerbation" 10 : OC13-OC17, 2016

11 Cheng T, "Obvious emphysema on computed tomography during an acute exacerbation of chronic obstructive pulmonary disease predicts a poor prognosis" 45 : 517-526, 2015

12 Sogaard M, "Incidence and outcomes of patients hospitalized with COPD exacerbation with and without pneumonia" 11 : 455-465, 2016

13 Global Initiative for Chronic Obstructive Lung Disease, "Global strategy for the diagnosis, management and prevention of COPD" Global Initiative for Chronic Obstructive Lung Disease 111-, 2016

14 Garcia-Sanz MT, "Factors associated with the incidence of serious adverse events in patients admitted with COPD acute exacerbation" 186 : 477-483, 2017

15 Abudagga A, "Exacerbations among chronic bronchitis patients treated with maintenance medications from a US managed care population : an administrative claims data analysis" 8 : 175-185, 2013

16 Cardinale L, "Effectiveness of chest radiography, lung ultrasound and thoracic computed tomography in the diagnosis of congestive heart failure" 6 : 230-237, 2014

17 Claessens YE, "Early chest computed tomography scan to assist diagnosis and guide treatment decision for suspected community-acquired pneumonia" 192 : 974-982, 2015

18 Hartmann IJ, "Diagnosing acute pulmonary embolism: effect of chronic obstructive pulmonary disease on the performance of D-dimer testing, ventilation/perfusion scintigraphy, spiral computed tomographic angiography, and conventional angiography. ANTELOPE Study Group. Advances in New Technologies Evaluating the Localization of Pulmonary Embolism" 162 : 2232-2237, 2000

19 Cheng T, "Computed tomography manifestation of acute exacerbation of chronic obstructive pulmonary disease : a pilot study" 11 : 519-529, 2016

20 Dixit D, "Acute exacerbations of chronic obstructive pulmonary disease: diagnosis, management, and prevention in critically ill patients" 35 : 631-648, 2015