Tuberc Respir Dis.  2019 Jul;82(3):234-241. 10.4046/trd.2018.0087.

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

• Park HJ
• Kim SH
• Kim HC
• Lee BY
• Lee SW
• Lee JS
• Lee SD
• Seo JB
• Oh YM

• KMID: 2450901
• DOI: http://doi.org/10.4046/trd.2018.0087

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.

Keyword

Disease Exacerbation; Pulmonary Disease, Chronic Obstructive; Hospitalization; Tomography, X-Ray Computed

MeSH Terms

Diagnosis*
Diagnosis, Differential*
Disease Progression
Hospitalization
Humans
Insurance, Health
Intensive Care Units
Length of Stay
Propensity Score
Pulmonary Disease, Chronic Obstructive*
Tomography, X-Ray Computed

Figure

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  Figure 1 Flow of patient selection. We excluded the patients with bronchiectasis, history of asthma and the patients with definite parenchymal infiltration on the initial chest X-ray. In addition, we excluded the patients who performed chest computed tomography (CT) before the initial chest X-ray or 48 hours after hospitalization and also excluded the patients who performed chest CT at a hospital or a clinic other than our medical center. Initial diagnosis of chronic obstructive pulmonary disease (COPD) exacerbation is aggravated respiratory symptoms in COPD patients and defined as no definite infiltration on initial chest X-ray.

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