Trial reportEuropean radiology2023
The yield of chest X-ray or ultra-low-dose chest-CT in emergency department patients suspected of pulmonary infection without respiratory symptoms or signs.
Trial report in European radiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
12 citing papers in PubMed, 15 citations in OpenAlex.
- Diagnostic accuracy of ultra-low-dose chest CT vs chest X-ray for acute non-traumatic pulmonary diseases.European radiology · 2025Trial
- The addition of computed tomography (CT) findings maintains the predictive performance of an existing radiograph-based donor lung acceptability score.The Journal of thoracic and cardiovascular surgery · 2026Article
- Article
- Diagnostic accuracy of chest radiograph versus computed tomography for suspected pneumonia in obese patients.Emergency radiology · 2026Article
- Impact of Increased Chest CT Utilization on the Diagnosis of Pneumonia in Older Adults: A Population-Based Study of 930,654 Individuals.Korean journal of radiology · 2025Article
- Lung ultrasound vs chest radiography for pneumonia diagnosis in critically ill patients in the intensive care unit: a systematic review and Bayesian network diagnostic meta-analysis.EClinicalMedicine · 2025Article
- Searching for Infectious Foci in Intensive Care Patients: Diagnostic Yield of Computed Tomography and Prognostic Value of Clinical and Laboratory Chemical Parameters.Journal of clinical medicine · 2025Article
- Clinical utility of bedside Contrast-Enhanced Ultrasound (CEUS) in the diagnosis of pneumonia in elderly patients: Comparison with clinical, -radiological and ultrasound diagnosis.Multidisciplinary respiratory medicine · 2024Article
- Computed tomography in patients with sepsis presenting to the emergency department: exploring its role in light of patient outcomes.European radiology · 2024Observational
- [Cancer patients in the emergency department].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2024Review
- Leveraging artificial intelligence in radiology education: challenges and opportunities.European radiology · 2023Article
- Ultra-low-dose CT vs. chest X-ray in non-traumatic emergency department patients - a prospective randomised crossover cohort trial.EClinicalMedicine · 2023Article
Corrections and comments
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Authors and funding
10 authors at 4 institutions in 1 country.
Funding
Abstract
objectiveThe yield of pulmonary imaging in patients with suspected infection but no respiratory symptoms or signs is probably limited, ultra-low-dose CT (ULDCT) is known to have a higher sensitivity than Chest X-ray (CXR). Our objective was to describe the yield of ULDCT and CXR in patients clinically suspected of infection, but without respiratory symptoms or signs, and to compare the diagnostic accuracy of ULDCT and CXR.
methodsIn the OPTIMACT trial, patients suspected of non-traumatic pulmonary disease at the emergency department (ED) were randomly allocated to undergo CXR (1210 patients) or ULDCT (1208 patients). We identified 227 patients in the study group with fever, hypothermia, and/or elevated C-reactive protein (CRP) but no respiratory symptoms or signs, and estimated ULDCT and CXR sensitivity and specificity in detecting pneumonia. The final day-28 diagnosis served as the clinical reference standard.
resultsIn the ULDCT group, 14/116 (12%) received a final diagnosis of pneumonia, versus 8/111 (7%) in the CXR group. ULDCT sensitivity was significantly higher than that of CXR: 13/14 (93%) versus 4/8 (50%), a difference of 43% (95% CI: 6 to 80%). ULDCT specificity was 91/102 (89%) versus 97/103 (94%) for CXR, a difference of - 5% (95% CI: - 12 to 3%). PPV was 54% (13/24) for ULDCT versus 40% (4/10) for CXR, NPV 99% (91/92) versus 96% (97/101).
conclusionPneumonia can be present in ED patients without respiratory symptoms or signs who have a fever, hypothermia, and/or elevated CRP. ULDCT's sensitivity is a significant advantage over CXR when pneumonia has to be excluded. CLINICAL RELEVANCE STATEMENT: Pulmonary imaging in patients with suspected infection but no respiratory symptoms or signs can result in the detection of clinically significant pneumonia. The increased sensitivity of ultra-low-dose chest CT compared to CXR is of added value in vulnerable and immunocompromised patients. KEY POINTS: • Clinical significant pneumonia does occur in patients who have a fever, low core body temperature, or elevated CRP without respiratory symptoms or signs. • Pulmonary imaging should be considered in patients with unexplained symptoms or signs of infections. • To exclude pneumonia in this patient group, ULDCT's improved sensitivity is a significant advantage over CXR.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.