Dyspnea
Conditions
Keywords
Dyspnea, ED, Chest CT-scan
Brief summary
In acute dyspnea, the use of chest radiography is frequent and not very contributive, especially in the elderly patients. However, early diagnosis of the cause of dyspnea in the ED is associated with a better prognosis, in particular for the identification of an infectious or cardiac origin. Chest CT has already shown better diagnostic performances than conventional radiography in several pathologies such as low respiratory infection, and the development of so-called low dose scans allows to limit the irradiation during this examination. The investigators aim to conduct a diagnostic study comparing non-injected chest CT-scan and conventional chest radiography in patients older than 65 presenting in the ED with acute dyspnea to assess whether CT-scan improves diagnosis.
Detailed description
Patients of 65 years and older presenting to the emergency department with acute dyspnea and for whom a chest radiography is mandatory will be screened for inclusion. If the inclusion criteria are met and in the absence of non-inclusion criteria, free and informed oral consent will be sought. Once the patient is included, management by the emergency physician will be routine. A non-injected chest CT scan will be requested to the emergency radiology department in addition to the chest radiography. As a result, an X-ray and then a CT scan will be performed in each patient. 3 diagnoses will be collected: 1. By the emergency physician in charge of the patient, after the chest X-ray and before the CT scan (DiagU1) 2. By the emergency physician in charge of the patient, after the results of the scan (DiagU2) 3. By an adjudication committee after review of the medical file (DiagExpert) A comparison will be made between the 3 diagnoses.
Interventions
OTHERCT scan
A CT scan will be requested for every patient in addition to the chest X-ray
Sponsors
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age greater than or equal to 65 years * Acute dyspnea (\< 1 week) * Prescription of a chest x-ray * Oral free and informed consent of the patient after information and delivery of the information note * Patient affiliated to a social security system
Exclusion criteria
* Inability to lie down * Chest imaging done within the last 7 days * Indication to perform a thoracic scan * Patient under guardianship or curatorship * Patient deprived of liberty, pregnant woman * Participation in other interventional research
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Improved diagnosis | 28 days after inclusion | Proportion of patients with bad diagnosis before scanning and good diagnosis after scanning (according to adjudication committee) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Discordant diagnosis | 28 days after inclusion | Proportion of patients with discordant pre- and post-scan diagnoses |
| Improvement in diagnostic certainty | 28 days after inclusion | Difference in Diagnostic certainty in percentage by self-assessment before and after scan |
| Scans performed | baseline (Day 0) | Proportion of patients for whom the scan was actually performed |
Countries
France
Contacts
Primary ContactYonathan FREUND, PU-PH
Backup ContactJudith GORLICKI, MD
Outcome results
None listed