Comparing imaging methods for diagnosing pneumonia in elderly patients

Low-dose CT Compared to Lung Ultrasonography vs Standard of Care for the Diagnosis of Pneumonia in the Elderly: a Multicentre Randomized Controlled Study

This study is testing which imaging method—Chest X-ray, low-dose CT scan, or lung ultrasound—works best for diagnosing pneumonia in older patients in the emergency room.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 495 (estimated)
• Ages: 65 Years and up
• Sex: All
• Sponsor: University Hospital, Geneva (Academic / other)
• Drugs / interventions: radiation
• Locations: 2 sites (Bern and 1 other locations)
• Trial ID: NCT04978116 on ClinicalTrials.gov

What this trial studies

This clinical trial aims to evaluate the diagnostic accuracy of three imaging strategies—Chest X-ray (CXR), low-dose CT scan (LDCT), and lung ultrasonography (LUS)—in elderly patients over 65 years old with suspected pneumonia in the emergency room. Patients will be randomly assigned to one of the imaging methods, with results from two methods masked for five days to ensure unbiased assessment. The primary goal is to compare the accuracy of LDCT against CXR, while secondary objectives include evaluating clinical outcomes and antibiotic usage. The study will be conducted across multiple academic and tertiary care hospitals in Switzerland.

Who should consider this trial

Good fit: Ideal candidates for this study are elderly patients over 65 years old presenting with symptoms suggestive of pneumonia in the emergency room.

Not a fit: Patients who have been admitted to the intensive care unit or have had pneumonia in the past three months may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could lead to more accurate pneumonia diagnoses in elderly patients, potentially improving treatment outcomes and reducing unnecessary antibiotic use.

How similar studies have performed: Other studies have explored imaging strategies for pneumonia diagnosis, but this specific comparison of LDCT, CXR, and LUS in the elderly is relatively novel.

Eligibility criteria

Inclusion criteria:

* Aged \>65 years
* Suspected community-acquired or nursing-home acquired pneumonia consulting to the emergency room with at least one respiratory symptom (new or increasing among: cough, purulent sputum, pleuritic chest pain, dyspnea, respiratory rate \>20/min, focal auscultatory findings or oxygen saturation \<90% on room air) AND at least one symptom or laboratory finding compatible with an infection (temperature \>37.8°C or \<36.0°C, C reactive protein (CRP) \>10 mg/L, PCT \>0.25 µg/L, leukocyte count \>10 G/L with \>85% neutrophils or band forms)
* Signed informed consent
* In the oldest old (patients aged \>80 years), the presence of acute delirium or unexplained acute fall can substitute for the presence of either the respiratory or the infectious symptom

Exclusion Criteria:

* Immediate admission to the intensive care unit (ICU)
* Pneumonia in the past 3 months
* PCR or antigenic test positive for SARS-CoV-2 in the 3 past weeks
* Transfer from another hospital with a diagnosis of pneumonia
* CXR or thoracic CT scan or US already done during the present episode
* Immediate contrast-enhanced CT scan needed
* Advanced care planning limiting therapy to comfort care only
* Prisoners
* Known uncontrolled psychiatric disorders
* Previous enrollment into the current study.

Where this trial is running

Bern and 1 other locations

• Inselspital — Bern, Switzerland (Not_yet_recruiting)
• Hôpital Trois-Chêne, Hôpitaux Universitaires de Genève — Geneva, Switzerland (Recruiting)

Study contacts

• Principal investigator: Virginie Prendki, Dr — University Hospital, Geneva
• Study coordinator: Virginie Prendki, Dr

Conditions Pneumonia; Elderly Infection; Chest X-ray; Low-dose CT scan; Lung ultrasonography