Fever, Fever of Unknown Origin, Inflammation, Inflammation of Unknown Origin
Conditions
Keywords
FDG-PET/CT, PET, fever of unknown origin
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.
Interventions
DIAGNOSTIC_TEST18F-FDG PET/CT
Nuclear medicine imaging as a diagnostic tool with implication for change in clinical management
Sponsors
University of Adelaide
Central Adelaide Local Health Network Incorporated
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Diagnostic yield | 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
| Measure | Time frame | Description |
|---|---|---|
| Clinical change in management | 30 days | • Clinical change in management: was clinical care altered compared to the documented plan prior to PET? 0 = no, 1 = yes * Yes: antimicrobial therapy, procedures/interventions (PET-guided site biopsy, or surgery/drainage), diagnostics e.g. further focussed imaging, or disposition e.g. palliative care transition * No: there was no change to the management plan, or the plan was already determined by other data Examples: * PET confirmed a suspected diagnosis but the treatment plan was unchanged * PET provided supporting evidence but no explicit management adjustment was documented * PET was negative and no further management steps were taken because there was a pre-existing plan |
| Change in antimicrobial management | 30 days | •Change in antimicrobial duration/spectrum/therapeutic procedure: this change occurred as a result of PET |
| Final diagnosis | 30 days | • Final diagnosis: infection = 1, non-infectious = 2, malignancy = 3, unresolved = 4 |
Countries
Australia
Outcome results
None listed