Utility of 18F-FDG PET/CT for Suspected Infection in the Inpatient Setting: a Single Centre Retrospective Cohort Study
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- University of Adelaide
- Enrollment
- 266
- Locations
- 1
- Primary Endpoint
- Diagnostic yield
Study Overview
Brief Summary
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.
Detailed Description
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 Design
- Study Type
- Observational
- Observational Model
- Cohort
- Time Perspective
- Retrospective
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Inpatient at the Royal Adelaide Hospital
- •FDG-PET/CT between 1st January 2022 - 31st December 2023
- •Imaging request query included: infect* AND/OR Fever of Unknown Origin OR FUO AND/OR Pyrexia of Unknown Origin OR PUO AND/OR inflammat*
Exclusion Criteria
- •- Outpatient PET/CT
- •Comparison imaging for established diagnosed infection
- •PET/CT intended for evaluation of malignancy
- •Evaluation of presumed or confirmed infective endocarditis
- •Age less than 18 years
Arms & Interventions
Low CRP prior to PET
Intervention: 18F-FDG PET/CT (Diagnostic Test)
Infectious diseases consultation
Intervention: 18F-FDG PET/CT (Diagnostic Test)
No infectious diseases consultation
Intervention: 18F-FDG PET/CT (Diagnostic Test)
Significant pre-PET imaging finding
Intervention: 18F-FDG PET/CT (Diagnostic Test)
No significant pre-PET imaging finding
Intervention: 18F-FDG PET/CT (Diagnostic Test)
High blood WCC prior to PET
Intervention: 18F-FDG PET/CT (Diagnostic Test)
Low WCC prior to PET
Intervention: 18F-FDG PET/CT (Diagnostic Test)
High CRP prior to PET
Intervention: 18F-FDG PET/CT (Diagnostic Test)
Outcomes
Primary Outcomes
Diagnostic yield
Time Frame: 30 days
• 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
Secondary Outcomes
- Clinical change in management(30 days)
- Change in antimicrobial management(30 days)
- Final diagnosis(30 days)
Investigators
James Kimber
Dr
University of Adelaide