Retrospective cohort study of inpatients at a South Australian tertiary hospital who underwent 18F FDG-PET/CT for investigation of undifferentiated fever or inflammatory syndrome. The aim is to investigate the utility of FDG-PET/CT in the investigation of suspected infection in hospitalised adults. To establish the rate at which FDG-PET/CT contributes to a diagnosis, and how this impacts clinical management and outcomes. From this, to develop further understanding of for which patients this imaging modality contributes meaningfully to outcomes.
A retrospective cohort study of consecutive adult inpatients undergoing 18F-FDG PET/CT for suspected infection or inflammation, excluding infective endocarditis and malignancy-directed scans. Pre-PET variables include inflammatory markers, microbiological results, prior imaging findings and infectious diseases (ID) consultation. PET/CT utility will be adjudicated as diagnostic and/or associated with a change in management using a structured consensus process. Associations between pre-PET factors and clinical utility will be explored using descriptive and logistic analyses.
Study Type
OBSERVATIONAL
Enrollment
266
Nuclear medicine imaging as a diagnostic tool with implication for change in clinical management
Royal Adelaide Hospital
Adelaide, South Australia, Australia
Diagnostic yield
• Did PET contribute to diagnostic yield?: * 1 = Yes: PET led to a finding either definitive e.g. confirmed by gold standard (microbiology, histopathology, intraoperative findings etc) or contributory, which guided diagnosis or management even without gold standard confirmation. Examples of contributory: PET showing vascular graft uptake, not explanted due to risk but presumptively treated Vertebral discitis suggested by PET, biopsied without culture, but presumptively treated and clinically improved PET negative - antibiotics ceased, patient remained well * 0 = No: PET provided no new information, was misleading (i.e. PET result contradicted by later results), or no action was taken based on PET
Time frame: 30 days
Clinical change in management
• Clinical change in management: was clinical care altered compared to the documented plan prior to PET? 0 = no, 1 = yes * Yes: antimicrobial therapy, procedures/interventions (PET-guided site biopsy, or surgery/drainage), diagnostics e.g. further focussed imaging, or disposition e.g. palliative care transition * No: there was no change to the management plan, or the plan was already determined by other data Examples: * PET confirmed a suspected diagnosis but the treatment plan was unchanged * PET provided supporting evidence but no explicit management adjustment was documented * PET was negative and no further management steps were taken because there was a pre-existing plan
Time frame: 30 days
Change in antimicrobial management
•Change in antimicrobial duration/spectrum/therapeutic procedure: this change occurred as a result of PET
Time frame: 30 days
Final diagnosis
• Final diagnosis: infection = 1, non-infectious = 2, malignancy = 3, unresolved = 4
Time frame: 30 days
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