Diagnostic Performance of Chest Computed Tomography Scan in Patients Aged 65 and Over Presenting to Emergency Room With Acute Dyspnea

Study Overview
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Brief Summary
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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
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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: By the emergency physician in charge of the patient, after the chest X-ray and before the CT scan (DiagU1) By the emergency physician in charge of the patient, after the results of the scan (DiagU2) By an adjudication committee after review of the medical file (DiagExpert) A comparison will be made between the 3 diagnoses.

Official Title
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Diagnostic Performance of Chest Computed Tomography Scan in Patients Aged 65 and Over Presenting to Emergency Room With Acute Dyspnea

Conditions
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Dyspnea

Intervention / Treatment
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* Other: CT scan


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: CT scan intervention<br> | Other: CT scan<br>* A CT scan will be requested for every patient in addition to the chest X-ray<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improved diagnosis | Proportion of patients with bad diagnosis before scanning and good diagnosis after scanning (according to adjudication committee) | 28 days after inclusion | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Discordant diagnosis | Proportion of patients with discordant pre- and post-scan diagnoses | 28 days after inclusion | 
| Improvement in diagnostic certainty | Difference in Diagnostic certainty in percentage by self-assessment before and after scan | 28 days after inclusion | 
| Scans performed | Proportion of patients for whom the scan was actually performed | baseline (Day 0) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Dyspnea, ED, Chest CT-scan