Clinical Utility of Indium 111–Labeled White Blood Cell Scintigraphy for Evaluation of Suspected Infection. (17th September 2014)

• Record Type: Journal Article
• Authors: Lewis, Sarah S.; Cox, Gary M.; Stout, Jason E.
• Is Part Of: Open forum infectious diseases. Volume 1:Number 2(2014)
• Publication Date: 2014-09-17
• Subjects: leukocyte scintigraphy -- nuclear imaging -- prosthetic graft infection -- osteomyelitis; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofu089
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract : We assessed the clinical utility of indium 111–labeled white blood cell scans at our tertiary referral center from 2005 to 2011. Overall, scans meaningfully impacted clinical care <50% of the time. Scan utility was greater for suspected vascular graft infections or osteomyelitis. Abstract : Background. We sought to characterize the clinical utility of indium 111 ( 111 In)–labeled white blood cell (WBC) scans by indication, to identify patient populations who might benefit most from this imaging modality. Methods. Medical records for all patients who underwent 111 In-labeled WBC scans at our tertiary referral center from 2005 to 2011 were reviewed. Scan indication, results, and final diagnosis were assessed independently by 2 infectious disease physicians. Reviewers also categorized the clinical utility of each scan as helpful vs not helpful with diagnosis and/or management according to prespecified criteria. Cases for which clinical utility could not be determined were excluded from the utility assessment. Results. One hundred thirty-seven scans were included in this analysis; clinical utility could be determined in 132 (96%) cases. The annual number of scans decreased throughout the study period, from 26 in 2005 to 13 in 2011. Forty-one (30%) scans were positive, and 85 (62%) patients were ultimately determined to have an infection. Of the evaluable scans, 63 (48%) scans were deemed clinically useful. Clinical utility varied by scan indication: 111 In-labeled WBC scans were more helpful for indications of osteomyelitis (35/50, 70% useful) or vascular access infection (10/15, 67% useful), and less helpful for evaluation of fever of unknown origin (12/35, 34% useful). Conclusions. 111 In-labeled WBC scans were useful for patient care less than half of the time at our center. Targeted ordering of these scans for indications in which they have greater utility, such as suspected osteomyelitis and vascular access infections, may optimize test utilization.