Influence of three factors on the diagnostic effectiveness of transthoracic needle aspiration in pneumonia.
Prior antibiotic therapy, size of the infiltrate, and the person who performed the technique were the three factors that we studied to assess their influence on the effectiveness of transthoracic needle aspiration (TNA). Ninety-one patients with a diagnosis of severe bacterial pneumonia, who underwent TNA, have been included in the study. The technique was carried out with an ultrathin needle gauge 25 and without fluoroscopic control. A univariate (UA) and a multivariate statistical analysis were made. The sensitivity of TNA was 34.1%. Fifty-seven of 91 (62.6%) had received antibiotic therapy prior to TNA; sensitivity was higher in nontreated patients than in treated patients (p = 0.0033; UA). There were 34 patients with an infiltrate that was smaller than a lobe (MINLOB); 39 cases affected a complete lobe (LOB) and 18 more than one lobe (MAJLOB). The TNA sensitivity was higher in LOB cases than in MINLOB cases (p = 0.0004; UA) while when comparing LOB cases and MAJLOB cases, sensitivity was higher in the former (p = NS; UA). In 28 of 91 cases (30.8%), the TNA was performed by A (a trained physician who regularly carries out the technique) and in 63 of 91 cases (69.2%) by B (other physicians, 10 in our study, who sporadically perform the technique). The TNA sensitivity was higher when the technique was performed by A, although this difference was not significant; if we add negative TNA with leukocytes present in Gram stains (which would indicate that aspiration was done in the correct area) to positive TNA, the difference between A and B was higher (p = 0.0248). The multivariate statistical analysis confirmed that there are two variables that are independently connected to a positive TNA (prior antibiotic therapy and size of the infiltrate). As regards the variable "person who carries out the technique," a significant association with a positive TNA was not established, although the estimations we obtained show a possible clinical relevance.
Zalacain
R
R
Servicio de Neumología, Hospital de Cruces, Vizcaya, Spain.
Llorente
J L
JL
Gaztelurrutia
L
L
Pijoan
J I
JI
Sobradillo
V
V
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001707:Biopsy, Needle; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011859:Radiography; D012680:Sensitivity and Specificity
D000900:Anti-Bacterial Agents