TY - JOUR
T1 - The impact of chest computed tomography and chest radiography on clinical management of cystic fibrosis lung disease
AU - Bortoluzzi, Carla F
AU - Pontello, Eleonora
AU - Pintani, Emily
AU - de Winter-de Groot, Karin M
AU - D'Orazio, Ciro
AU - Assael, Baroukh M
AU - Hunink, M G Myriam
AU - Tiddens, Harm A W M
AU - Caudri, Daan
N1 - Funding Information:
The project has been funded by an Italian Fondazione Ricerca Fibrosi Cistica Onlus ( Delegazione FFC Pesaro and Audemars Piguet , grant project FFC#23/2013 ), titled “The impact of chest computed tomography on clinical management of CF lung disease” (30,000 euro) and by Fonds NutsOhra , The Netherlands under number 1305-184 with project title: “CT-scan of thoraxfoto van de longen bij kinderen met Cystic Fibrose?” (42,274 euro). None of the funding sources were involved in data collection, analysis or interpretation.
Funding Information:
Dr. Tiddens reports “Industry symposium on treatment in CF” from Roche, “Lectures, advisory boards” from Novartis, and grants from CFF, Vertex, Gilead, and Chiesi. In addition, Dr. Tiddens has a patent Vectura licensed, and a patent PRAGMA-CF scoring system issued and he is heading the Erasmus MC-Sophia Children's Hospital core laboratory Lung Analysis. Dr. Hunink reports personal fees from Cambridge University Press, grants and non-financial support from European Society of Radiology (ESR), non-financial support from European Institute for Biomedical Imaging Research. The other authors have no conflicts of interest to disclose.
Publisher Copyright:
© 2019 European Cystic Fibrosis Society.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/7
Y1 - 2020/7
N2 - BACKGROUND: Recent standards of care mention chest radiography (CR) but not chest computed tomography (CT) in routine annual follow-up of children with cystic fibrosis (CF). To minimise radiation risk, CT or CR should only be performed if they impact clinical decision making. We investigated whether in addition to a wide range of commonly used clinical parameters, chest CT and/or CR in routine follow-up of CF patients influence clinical decisions.METHODS: 36 web based clinical vignettes (i.e. case simulations) were designed using clinical data from patients aged 8-18 years, randomly selected from two CF centres in The Netherlands. In a randomized cross-over design, clinicians assessed eight vignettes and suggested therapeutic/diagnostic management on two occasions, with a ten-week interval. Radiological information (CT or CR) was included at only one of the two assessments, in random order. Any differences in management could be attributed to information from CT or CR, and were compared by McNemar analysis.RESULTS: 44 European and Australian clinicians completed a total of 143 CT vignette pairs and 167 CR vignette pairs. CT was associated with a significant increase in antifungal treatment (Risk Ratio (RR) 2.8 (1.3-6.0, p = .02)), bronchoscopies (RR 1.6 (1.1-2.5, p = .04)), mycobacterial cultures (RR 1.3 (1.0-1.5, p = .02)), and 'need for hospitalization' (i.e. intravenous antibiotics and/or bronchoscopy) (RR 1.4 (1.0-1.9, p = .03)). CR led to a significant increase in inhaled antibiotics only (RR 1.3 (1.0-1.6, p = .04)).CONCLUSIONS: CT but not CR, at routine biennial follow-up was associated with several changes in treatment and/or diagnostic testing, including the need for hospitalization.
AB - BACKGROUND: Recent standards of care mention chest radiography (CR) but not chest computed tomography (CT) in routine annual follow-up of children with cystic fibrosis (CF). To minimise radiation risk, CT or CR should only be performed if they impact clinical decision making. We investigated whether in addition to a wide range of commonly used clinical parameters, chest CT and/or CR in routine follow-up of CF patients influence clinical decisions.METHODS: 36 web based clinical vignettes (i.e. case simulations) were designed using clinical data from patients aged 8-18 years, randomly selected from two CF centres in The Netherlands. In a randomized cross-over design, clinicians assessed eight vignettes and suggested therapeutic/diagnostic management on two occasions, with a ten-week interval. Radiological information (CT or CR) was included at only one of the two assessments, in random order. Any differences in management could be attributed to information from CT or CR, and were compared by McNemar analysis.RESULTS: 44 European and Australian clinicians completed a total of 143 CT vignette pairs and 167 CR vignette pairs. CT was associated with a significant increase in antifungal treatment (Risk Ratio (RR) 2.8 (1.3-6.0, p = .02)), bronchoscopies (RR 1.6 (1.1-2.5, p = .04)), mycobacterial cultures (RR 1.3 (1.0-1.5, p = .02)), and 'need for hospitalization' (i.e. intravenous antibiotics and/or bronchoscopy) (RR 1.4 (1.0-1.9, p = .03)). CR led to a significant increase in inhaled antibiotics only (RR 1.3 (1.0-1.6, p = .04)).CONCLUSIONS: CT but not CR, at routine biennial follow-up was associated with several changes in treatment and/or diagnostic testing, including the need for hospitalization.
KW - Chest radiography
KW - Clinical management
KW - Computed tomography
KW - Cystic fibrosis
UR - http://www.scopus.com/inward/record.url?scp=85071662798&partnerID=8YFLogxK
U2 - 10.1016/j.jcf.2019.08.005
DO - 10.1016/j.jcf.2019.08.005
M3 - Article
C2 - 31494047
SN - 1569-1993
VL - 19
SP - 641
EP - 646
JO - Journal of Cystic Fibrosis
JF - Journal of Cystic Fibrosis
IS - 4
ER -