Ultra-low Dose Chest Computed Tomography: a Rule-out Tool for Community-acquired Pneumonia

Hospital Israelita Albert Einstein237 enrolled

Overview

This is a randomized study that sought to compare the rule-out capacity and antibiotics prescriptions associated with two different diagnostic imaging strategies (ultra-low-dose chest computed tomography versus chest radiography) in a group of healthy adults presenting to the emergency department (ED) with suspected community-acquired pneumonia (CAP).

Between October 2017 and December 2018, we prospectively enrolled consecutive adult patients with suspected community-acquired pneumonia based on at least one respiratory symptom and focal auscultatory findings and at least one sign related to infection, for whom no definitive diagnosis was possible by clinical judgment. Eligible patients were randomly assigned to their imaging evaluation in a 1:1 ratio to either ultra-low-dose chest computed tomography (ULDCT) or the standard evaluation strategy using conventional chest radiography (CR). This study sought to compare the rule-out capacity and antibiotics prescriptions associated with those two different diagnostic imaging strategies (ULDCT versus CR) in a group of healthy adult patients presenting to the ED with suspected CAP.

Study Type

OBSERVATIONAL

Enrollment

237

Conditions

Pneumonia Diagnoses Disease

Interventions

CRDIAGNOSTIC_TEST

Lung imaging evaluation performed with CR

ULDCTDIAGNOSTIC_TEST

Lung imaging evaluation performed with ULDCT

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Suspected CAP; * At least one respiratory symptom (new or increasing cough, expectoration, dyspnea or chest pain) and * At least one symptom related to infection (fever ≥ 38°C, chills, sweating, myalgia, mental confusion or headache) and * Focal auscultatory findings during physical examinations (crackling rales) * No definitive diagnosis possible by clinical judgment. Exclusion Criteria: * Score in at least one clinical part of the CURB-65 or PSA scores * Clinical diagnosis of rhinosinusitis and acute nasopharyngitis and who had already been treated with antimicrobial therapy for this episode of disease * pregnancy; * the presence of other respiratory diseases such as chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease, chronic diseases or other chronic airway conditions; * diagnosis of congestive heart failure; * body mass index (BMI) greater than 30; * inability to hold the breath for at least 10 seconds

Locations (1)

Hospital Israelita Albert Einstein

São Paulo, São Paulo, Brazil

Outcomes

Primary Outcomes

Community-acquired pneumonia rule-out capability

Number of Participants for whom ULDCT could diagnose absence of imaging signs of pneumonia

Time frame: 1 month

Antibiotics prescription

Number of Participants for whom antibiotics were prescribed to treat bacterial pneumonia

Time frame: immediate

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.