TY - JOUR
T1 - Ultra-low-dose CT versus chest X-ray for patients suspected of pulmonary disease at the emergency department
T2 - a multicentre randomised clinical trial
AU - Van Den Berk, Inge A.H.
AU - Kanglie, Maadrika M.N.P.
AU - Van Engelen, Tjitske S.R.
AU - Altenburg, Josje
AU - Annema, Jouke T.
AU - Beenen, Ludo F.M.
AU - Boerrigter, Bart
AU - Bomers, Marije K.
AU - Bresser, Paul
AU - Eryigit, Elvin
AU - Groenink, Maarten
AU - Hochheimer, Suzanne M.R.
AU - Holleman, Frits
AU - Kooter, Jos A.J.
AU - Van Loon, Ramon B.
AU - Keijzers, Mitran
AU - Van Der Lee, Ivo
AU - Luijendijk, Paul
AU - Meijboom, Lilian J.
AU - Middeldorp, Saskia
AU - Schijf, Laura J.
AU - Soetekouw, Robin
AU - Sprengers, Ralf W.
AU - Montauban Van Swijndregt, Alexander D.
AU - De Monyé, Wouter
AU - Ridderikhof, Milan L.
AU - Winter, Michiel M.
AU - Bipat, Shandra
AU - Dijkgraaf, Marcel G.W.
AU - Bossuyt, Patrick M.M.
AU - Prins, Jan M.
AU - Stoker, Jaap
AU - OPTIMACT study group
N1 - Publisher Copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/4/13
Y1 - 2023/4/13
N2 - Background: Chest CT displays chest pathology better than chest X-ray (CXR). We evaluated the effects on health outcomes of replacing CXR by ultra-low-dose chest-CT (ULDCT) in the diagnostic work-up of patients suspected of non-traumatic pulmonary disease at the emergency department. Methods: Pragmatic, multicentre, non-inferiority randomised clinical trial in patients suspected of non-traumatic pulmonary disease at the emergency department. Between 31 January 2017 and 31 May 2018, every month, participating centres were randomly allocated to using ULDCT or CXR. Primary outcome was functional health at 28 days, measured by the Short Form (SF)-12 physical component summary scale score (PCS score), non-inferiority margin was set at 1 point. Secondary outcomes included hospital admission, hospital length of stay (LOS) and patients in follow-up because of incidental findings. Results: 2418 consecutive patients (ULDCT: 1208 and CXR: 1210) were included. Mean SF-12 PCS score at 28 days was 37.0 for ULDCT and 35.9 for CXR (difference 1.1; 95% lower CI: 0.003). After ULDCT, 638/1208 (52.7%) patients were admitted (median LOS of 4.8 days; IQR 2.1-8.8) compared with 659/1210 (54.5%) patients after CXR (median LOS 4.6 days; IQR 2.1-8.8). More ULDCT patients were in follow-up because of incidental findings: 26 (2.2%) versus 4 (0.3%). Conclusions: Short-term functional health was comparable between ULDCT and CXR, as were hospital admissions and LOS, but more incidental findings were found in the ULDCT group. Our trial does not support routine use of ULDCT in the work-up of patients suspected of non-traumatic pulmonary disease at the emergency department. Trial registration number: NTR6163.
AB - Background: Chest CT displays chest pathology better than chest X-ray (CXR). We evaluated the effects on health outcomes of replacing CXR by ultra-low-dose chest-CT (ULDCT) in the diagnostic work-up of patients suspected of non-traumatic pulmonary disease at the emergency department. Methods: Pragmatic, multicentre, non-inferiority randomised clinical trial in patients suspected of non-traumatic pulmonary disease at the emergency department. Between 31 January 2017 and 31 May 2018, every month, participating centres were randomly allocated to using ULDCT or CXR. Primary outcome was functional health at 28 days, measured by the Short Form (SF)-12 physical component summary scale score (PCS score), non-inferiority margin was set at 1 point. Secondary outcomes included hospital admission, hospital length of stay (LOS) and patients in follow-up because of incidental findings. Results: 2418 consecutive patients (ULDCT: 1208 and CXR: 1210) were included. Mean SF-12 PCS score at 28 days was 37.0 for ULDCT and 35.9 for CXR (difference 1.1; 95% lower CI: 0.003). After ULDCT, 638/1208 (52.7%) patients were admitted (median LOS of 4.8 days; IQR 2.1-8.8) compared with 659/1210 (54.5%) patients after CXR (median LOS 4.6 days; IQR 2.1-8.8). More ULDCT patients were in follow-up because of incidental findings: 26 (2.2%) versus 4 (0.3%). Conclusions: Short-term functional health was comparable between ULDCT and CXR, as were hospital admissions and LOS, but more incidental findings were found in the ULDCT group. Our trial does not support routine use of ULDCT in the work-up of patients suspected of non-traumatic pulmonary disease at the emergency department. Trial registration number: NTR6163.
KW - emergency medicine
KW - imaging/CT MRI etc
KW - pneumonia
KW - respiratory infection
UR - http://www.scopus.com/inward/record.url?scp=85132197147&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/thoraxjnl-2021-218337
DO - https://doi.org/10.1136/thoraxjnl-2021-218337
M3 - Article
C2 - 35688623
SN - 0040-6376
VL - 78
SP - 515
EP - 522
JO - Thorax
JF - Thorax
IS - 5
M1 - thoraxjnl-2021-218337
ER -