Summary

Added value of systematic chest computed tomography in older emergency patients complaining with dyspnea for the diagnosis of acute pulmonary oedema and respiratory tract infection: a multicenter interventional diagnostic study

Amélie Vromant1, Héloïse Bannelier1,2, Maxime Soen3, Pierre-Clément Thiebaud4, Alexandra Rousseau3, Aurélien Baud5, Alexandre Faure6, Laurence Monnier-Cholley7, Olivier Lucidarme8, Yonathan Freund1,2, Judith Gorlicki9

Affiliation of the authors

1Emergency Department, Hôpital Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, París, France. 2Sorbonne Université, París, France. 3Department of Clinical Pharmacology and Clinical Research Platform Paris-East (URCEST-CRC-CRB), St Antoine Hospital, AP-HP, París, France. 4Sorbonne Université, INSERM, Sorbonne Public Health Institute, Équipe PEPITES, AP-HP, Hôpital Saint-Antoine, Service d’accueil des urgences, 75012, París, France. 5Emergency Department, Hôpital Tenon, Assistance Publique Hôpitaux, París, France. 6Radiology Department, Hôpital Tenon, Assistance Publique Hôpitaux, París, France. 7Radiology Department, Hôpital Saint Antoine, Assistance Publique Hôpitaux, París, France. 8Sorbonne Université, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale (LIB). Radiology Department, Hôpital Pitié Salpêtrière, Assistance Publique Hôpitaux, París, France. 9Université Sorbonne Paris Nord. Emergency Department, Hôpital Avicenne, Assistance Publique Hôpitaux de Paris, Bobigny, France. Laboratoire MASCOT, Inserm UMR-S 942, París, France.

DOI

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Vromant A, Bannelier H, Soen M, Thiebaud PC, Rousseau A, Baud A, et al. Added value of systematic chest computed tomography in older emergency patients complaining with dyspnea for the diagnosis of acute pulmonary oedema and respiratory tract infection: a multicenter interventional diagnostic study. Emergencias. 2026;38:423-31

Summary

Objectives.

To evaluate the additional diagnostic value of systematic chest computed tomopraphy (CT) for these diagnoses in patients aged 65 and older with acute dyspnea.

Methods.

Prospective, interventional diagnostic study in three emergency departments (EDs) in Paris, France. Eligible patients underwent a non-contrast chest CT after initial chest radiography The emergency physician assessed each diagnosis (acute pulmonary oedema and respiratory tract infection) after radiography, then after CT. Two blinded experts adjudicated the reference diagnosis from the complete hospital course. The added value of CT was assessed using net diagnostic improvement (absolute difference in the proportion correctly classified before and after CT) and net reclassification index (NRI).

Results.

Of 244 patients, 239 were analyzed. The reference diagnosis was acute pulmonary oedema in 80 patients (33.5%) and respiratory tract infection in 151 (63.2%). Correct classification rose from 79.9% to 89.1% for acute pulmonary oedema (net improvement 9.2% (95% CI 3.9 to 14.5%) ; NRI 14.5% (95% CI 3.5 to 25.5%)) and from 70.3% to 86.2% for respiratory tract infection (net improvement of 15.9% (95% CI 9.8 to 22%); NRI of 36.5% (95% CI 22.4 to 50.7%)).

Conclusions.

Adding chest CT to chest radiography improved diagnostic classification of acute pulmonary edema and respiratory tract infection in patients coming to the ED complaining with dyspnea. These findings raise the hypothesis, requiring prospective evaluation, that the benefit is greatest when the diagnosis remains uncertain after initial assessment.

 

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