title: Diagnostic yield and safety of CT scans in ICU.
abstract: OBJECTIVE
  Critically ill patients often require CT scans. Adverse events (AE) can occur during intra-hospital transport (IHT). The aim of this prospective study was to determine the diagnostic and therapeutic yield and the safety of CT scans in ICU patients.
  
  
  METHODS
  All ICU patients having a CT scan for diagnostic purposes were eligible. Diagnostic yield was evaluated by the agreement (full, partial or disagreement) between the physician main diagnostic hypothesis before the CT scan and the diagnosis established after the CT scan. Therapeutic yield was assessed by therapeutic changes after the CT scan. The safety was determined by the AE rate during IHT.
  
  
  RESULTS
  A total of 533 CT scans were performed on 359 patients in three teaching hospital ICUs. The diagnostic yield of CT scan showed 40.7 % of full agreement, 5.6 % of partial agreement and 53.7 % of disagreement with the main diagnostic hypothesis formulated before the CT scan. The CT-scan brought new elements to the diagnosis in 22.9 % of the cases. There was 54.4 % of therapeutic change after CT scan, while 22.3 % of AE occurred during IHT, including 6.7 % of life-threatening events. AE occurred more frequently in the first 48 h after ICU admission, in the most severely ill patients (higher SAPS II at admission), and when there was a large amount of equipment required for transport.
  
  
  CONCLUSIONS
  The CT scan as a diagnostic procedure invalidated a diagnostic hypothesis and led to a therapeutic change in more than half of the cases.
authors.affiliation: Réanimation des Détresses Respiratoires et des Infections Sévères, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France, marinealiaga@hotmail.com.
authors.forename: Marine
authors.initials: M
authors.lastname: Aliaga
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Forel
authors.forename: Sophie
authors.initials: S
authors.lastname: De Bourmont
authors.forename: Boris
authors.initials: B
authors.lastname: Jung
authors.forename: Guillemette
authors.initials: G
authors.lastname: Thomas
authors.forename: Martin
authors.initials: M
authors.lastname: Mahul
authors.forename: Magali
authors.initials: M
authors.lastname: Bisbal
authors.forename: Stephanie
authors.initials: S
authors.lastname: Nougaret
authors.forename: Sami
authors.initials: S
authors.lastname: Hraiech
authors.forename: Antoine
authors.initials: A
authors.lastname: Roch
authors.forename: Kathia
authors.initials: K
authors.lastname: Chaumoitre
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.forename: Marc
authors.initials: M
authors.lastname: Gainnier
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011446:Prospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014187:Transportation of Patients