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Should Postpneumonia Chest Imaging Be Routine Practice?
March 2014, Vol 145, No. 3_MeetingAbstracts Chest Infections | March 2014
Should Postpneumonia Chest Imaging Be Routine Practice? Luke Surry, MD; Michael Morris, MD; William Hannah, MD San Antonio Military Medical Center, Fort Sam Houston, TX
Chest. 2014;145(3_MeetingAbstracts):149A. doi:10.1378/chest.1826508
Abstract SESSION TITLE: Respiratory Infections Posters SESSION TYPE: Poster Presentations PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM PURPOSE: Chest imaging 4-8 weeks following diagnosis of community-acquired pneumonia (CAP) is a routine and historically recommended practice. There is insufficient data to support this practice and the most recent recommendations are mute on the subject. This study examines the real-world practice of chest imaging following CAP; the rate persistent radiographic abnormalities; and the association of persistent abnormalities with clinical risk factors and subsequent non-malignant and malignant pulmonary diseases. METHODS: A retrospective chart-review of DOD electronic medical records dated 2005 to 2010 was completed. Patients aged 18-65 years with CAP-related ICD-9 coded events were included. From these events, a convenience cohort of 1667 patients was selected for preliminary review. After exclusion for inadequate follow-up, clear cases of HAP/VAP, and incorrect coding, 1455 cases were included in preliminary analysis. Imaging studies were broadly categorized as “normal” or “abnormal” at diagnosis and follow-up. Demographic data, smoking history, and prior pulmonary disease were documented along with post-pneumonia diagnoses of malignant and non-malignant pulmonary disease. RESULTS: Of 882 patients with abnormal initial imaging, only 464 (52%) completed reimaging at a median interval of 36 days. Persistent radiographic abnormalities were documented in 168 cases (36%) at median image interval of 27.5 days. New diagnoses of COPD or asthma were made in 10 cases (6%) with median follow-up of 39.4 months. New pulmonary malignancy was
diagnosed in 6 cases (3.5%) at median follow-up of 45.8 months. In this group, only 1 patient diagnosed with pulmonary malignancy and 2 diagnosed with COPD or asthma were nonsmokers. CONCLUSIONS: Reimaging following diagnosis of pneumonia in this study population was inconsistently practiced. Persistent radiographic abnormalities were noted in approximately 1/3 of patients at follow-up, consistent with previous studies. Although infrequent, new nonmalignant pulmonary disease was more common than pulmonary malignancy. CLINICAL IMPLICATIONS: Preliminary review supports discretionary reimaging with prognostic implications for long-term diagnosis of malignant and non-malignant pulmonary disease. Multivariate analysis is ongoing to clarify factors that may guide more judicious reimaging following CAP. DISCLOSURE: The following authors have nothing to disclose: Luke Surry, Michael Morris, William Hannah No Product/Research Disclosure Information
Should Postpneumonia Chest Imaging Be Routine Practice? Luke Surry, MD; Michael Morris, MD; William Hannah, MD San Antonio Military Medical Center, Fort Sam Houston, TX
Chest. 2014;145(3_MeetingAbstracts):149A. doi:10.1378/chest.1826508
Abstract SESSION TITLE: Respiratory Infections Posters SESSION TYPE: Poster Presentations PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM PURPOSE: Chest imaging 4-8 weeks following diagnosis of community-acquired pneumonia (CAP) is a routine and historically recommended practice. There is insufficient data to support this practice and the most recent recommendations are mute on the subject. This study examines the real-world practice of chest imaging following CAP; the rate persistent radiographic abnormalities; and the association of persistent abnormalities with clinical risk factors and subsequent non-malignant and malignant pulmonary diseases. METHODS: A retrospective chart-review of DOD electronic medical records dated 2005 to 2010 was completed. Patients aged 18-65 years with CAP-related ICD-9 coded events were included. From these events, a convenience cohort of 1667 patients was selected for preliminary review. After exclusion for inadequate follow-up, clear cases of HAP/VAP, and incorrect coding, 1455 cases were included in preliminary analysis. Imaging studies were broadly categorized as “normal” or “abnormal” at diagnosis and follow-up. Demographic data, smoking history, and prior pulmonary disease were documented along with post-pneumonia diagnoses of malignant and non-malignant pulmonary disease. RESULTS: Of 882 patients with abnormal initial imaging, only 464 (52%) completed reimaging at a median interval of 36 days. Persistent radiographic abnormalities were documented in 168 cases (36%) at median image interval of 27.5 days. New diagnoses of COPD or asthma were made in 10 cases (6%) with median follow-up of 39.4 months. New pulmonary malignancy was
diagnosed in 6 cases (3.5%) at median follow-up of 45.8 months. In this group, only 1 patient diagnosed with pulmonary malignancy and 2 diagnosed with COPD or asthma were nonsmokers. CONCLUSIONS: Reimaging following diagnosis of pneumonia in this study population was inconsistently practiced. Persistent radiographic abnormalities were noted in approximately 1/3 of patients at follow-up, consistent with previous studies. Although infrequent, new nonmalignant pulmonary disease was more common than pulmonary malignancy. CLINICAL IMPLICATIONS: Preliminary review supports discretionary reimaging with prognostic implications for long-term diagnosis of malignant and non-malignant pulmonary disease. Multivariate analysis is ongoing to clarify factors that may guide more judicious reimaging following CAP. DISCLOSURE: The following authors have nothing to disclose: Luke Surry, Michael Morris, William Hannah No Product/Research Disclosure Information