Chest CT-scan for the Diagnosis of Community-acquired Pneumonia in Patients Visiting the Emergency Department
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 339
- 试验地点
- 8
- 主要终点
- Chest CT-scan
研究概览
简要总结
Primary objective : to estimate impact of CT-scan on diagnostic for emergency department (ED) patients with suspected Community-acquired Pneumonia (CAP).
Secondary objective: to estimate impact of CT-scan on treatment (antimicrobial therapy) and site of care for ED patients with suspected CAP.
详细描述
Rational: Community-acquired pneumonia (CAP) is a frequent infectious disorder in patients visiting the ED. CAP is responsible for high morbidity and associated-mortality is increasing in Western countries. CAP corresponds to invasion of the lung by pathogens. Diagnosis depends on clinical and X-ray assessment. However, these signs and symptoms are poorly specific and are often lacking. As prognosis depends on precocious and fitted antimicrobial treatment, making CAP diagnosis in a short time span (4-8 hours) is mandatory. Preliminary studies suggest that chest CT-scan could over-performed X-ray for diagnosis of CAP. Consensus conferences suggest the use of CT-scan in patients with uncertain diagnosis and unusual presentation and outcome. Because CT-scan is currently easily available, its use in a first intent is questionable for ED patients with suspected CAP.
Primary objective: to estimate impact of CT-scan on diagnostic for ED patients with suspected CAP.
Secondary objective: to estimate impact of CT-scan on treatment (antimicrobial therapy) and site of care for ED patients with suspected CAP.
Prospective multicenter study to measure chest CT-scan impact. 350 patients visiting the ED of 4 inner tertiary teaching hospitals in Paris, France, with suspected CAP.
Management: Patients will be managed according to current guidelines, including conventional chest X-ray.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Diagnostic
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patient above 18 years of age
- •Patient with a presumptive diagnosis of CAP according to attending ED physician
- •Patient experiencing at least one systemic sign (T°>38°C or < 36°C, HR>90/min, RR>20/min)
- •Patient experiencing one respiratory sign (cough, lateral chest pain, localized crackles, dyspnea) that recently appeared
- •Patient with a prior medical examination, the results have been or will be communicated
- •Patient gave written informed consent or in cases of emergency parent/ support person who gave written informed consent if he/she is present on the day of inclusion
排除标准
- •Pregnancy
- •Patient with shock
- •Patient with respiratory distress and immune suppression
- •Patient with other criteria for immediate ICU referral to ICU
- •Patient with living conditions making it impossible to follow 28 days
- •Patient not affiliated with a social security system
结局指标
主要结局
Chest CT-scan
时间窗: in 28 days
Percentage of diagnoses modified by chest CT-scan.
次要结局
- Treatments changes(in 28 days)
- Changes of site-of-care(in 28 days)
- Identification of viral and bacterial agents(at day of inclusion (day 1))
- Markers of infection in the blood(at day of inclusion (day 1))
- Markers of infection and markers of inflammation in urine(at day of inclusion (day 1))