Predictive factors for identifying infection source using combined chest-abdominal computed tomography in acute febrile older patients exhibiting no clinical indications in the emergency department

Diagnosing fever in older patients is challenging because of atypical symptom presentation. Understanding which factors can predict an infection source on systemic computed tomography (CT) scans can improve patient outcomes by informing treatment decisions. This study aimed to investigate the predictive factors for identifying infection source using combined chest and abdominal CT in older febrile patients exhibiting no clear indications in the emergency department (ED). This was a single-center retrospective study that enrolled 169 acute febrile older patients without any clinical evidence of fever, who underwent systemic CT in the ED between January 2017 and June 2019. Fever in older patients was defined as tympanic temperature ≥37.2 ℃or an increase in body temperature by ≥1.3 ℃. Lack of clinical evidence of fever included an absence of suggestive findings in medical history, review of systems, physical examination or basic emergency diagnostic tests. CT results revealed 98 and 71 patients with negative and positive infection sources, respectively. Multivariate logistic regression analysis identified underlying diabetes mellitus (odds ratio (OR) = 2.667, 95% confidence interval (CI): 1.209–5.883, p = 0.015) and malignancy (OR = 13.272, 95% CI: 2.590–67.990, p = 0.002), quick Sequential Organ Failure Assessment score of 2 or more (≥2 points) (OR = 6.687, 95% CI: 2.568–17.410, p < 0.001), and serum C-reactive protein greater than 5.15 mg/dL (>5.15 mg/dL) (OR = 9.773, 95% CI: 3.944–24.217, p < 0.001) as independent predictive factors for infection source in acute febrile older patients showing no clinical evidence in the ED. Physicians could consider recommending systemic CT scans when there is a high clinical benefit for acute febrile older patients who lack clear evidence of fever but have the predictive factors identified in this study.

Aged; Emergency department; Fever; Infections; Tomography

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