Computed tomography for the identification of a potential infectious source in critically ill surgical patients

Introduction: Computed tomography (CT) seems already to have an important role to identify an infectious source in the management of patients with sepsis. However, our daily clinical behavior in ordering CT imaging was never scrutinized. Methods: We conducted a retrospective single-center analysis of CT and its therapeutic consequences in an operative intensive care unit in a tertiary care hospital in Germany. All CTs of the abdomen and/or thorax between 1st January and 31st December 2012 were included. One hundred forty-four CT studies were enrolled: 60.4% visceral, 6.9% vascular, 17.4% thoracic, and 14.6% trauma surgical cases and in 0.7% other disciplines. Results: In 76 CT studies (52.8%), a source of infection was found and was associated with a change in treatment in 65 (85.5%) cases. In contrast, in patients without identification of an infectious source in the CT imaging, treatment was changed after CT imaging in 11 (16.2%) cases. Computed tomography provided positive findings predominantly in the organ or the region of the surgical field. Conclusions: Computed tomographic imaging detected an infectious source in more than 50% of cases. Our data suggest that CT should be recommended to identify a source of infection in critically ill patients. Furthermore, prospective studies are needed to investigate the potential impact of CT imaging on outcome and to define criteria when to perform a CT imaging study. (C) 2014 Elsevier Inc. All rights reserved.