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Community-acquired pneumonia (CAP) is frequently suspected in the Emergency Department (ED). However, usual diagnosis procedure based on clinical features and chest X-Ray has rather bad performances.
A recent study on CT performance in suspected CAP found that 58% of classifications were modified by CT when compared with usual procedure. However, extended CT usage in CAP diagnosis is associated with many limitations :
availability in a majority of ED, delay, cost and irradiation, in particular In young patients.
Lung Ultrasound (LUS) has good performances in CAP diagnosis even when compared with CT. It is a rapid, inexpensive, radiation-free tool available in a majority of ED. It is performed at the patient's bedside with immediate results. The learning curve allows Emergency Physicians (EP) to perform this exam after a relative brief training.
The Investigators aim to investigate LUS performances in clinically suspected CAP authentication , and assesses specific diagnostic contributions and impact on antibiotic prescriptions .
120 patients will be enrolled on CAP suspicion. All explorations (radiography…) and biological exams (blood culture…) will be performed as usual to build physician primary diagnosis. Complementarily, an EP will be realized and final diagnosis will be made by physician. Finally, at Day28 expert adjudication committee will authentic diagnosis considering explorations and clinical issues. Frequency of discordant diagnosis between 1st and 2nd assessment and against expert will be measured Primary Purpose: diagnostic Study Phase: Not Applicable Intervention Model: NA Number of Arms: 1 Masking: open label, Masked Roles: NA Allocation: NA Study Endpoint Classification: efficacy Enrollment: 120 subjects (anticipated )
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| no intervention | Other | Non applicable |
| Measure | Description | Time Frame |
|---|---|---|
| Frequency of PAC classification modification (definite, probable, possible, excluded) after LUS realization | 95% confidence interval of CAP classification modification frequency before and after LUS realization | Day 0 |
| Measure | Description | Time Frame |
|---|---|---|
| Concordancy of CAP classification diagnosis concordancy ( after LUS) compared to adjudication committee | CAP classification (definite, probable, possible, excluded) and kappa coefficient. | 28 days after enrollment |
| Frequency of Antibiotic prescription modification after LUS |
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Inclusion Criteria :
- clinical suspicion of PAC
Exclusion Criteria :
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120 patients will be enrolled on CAP suspicion. All explorations (radiography…) and biological exams (blood culture…) will be performed as usual to build physician primary diagnosis. Complementarily, an EP will be realized and final diagnosis will be made by physician. Finally, at Day28 expert adjudication committee will authentify diagnosis considering explorations and clinical issues. Frequency of discordant diagnosis between 1st and 2nd assessment and against expert will be measured
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| Name | Affiliation | Role |
|---|---|---|
| Philippe Le Conte, Pr | Nantes University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| La Roche Sur Yon Hospital | La Roche-sur-Yon | 85925 | France | |||
| Nantes University Hospital |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 34561254 | Derived | Javaudin F, Marjanovic N, de Carvalho H, Gaborit B, Le Bastard Q, Boucher E, Haroche D, Montassier E, Le Conte P. Contribution of lung ultrasound in diagnosis of community-acquired pneumonia in the emergency department: a prospective multicentre study. BMJ Open. 2021 Sep 24;11(9):e046849. doi: 10.1136/bmjopen-2020-046849. |
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| ID | Term |
|---|---|
| D000098968 | Community-Acquired Pneumonia |
| D004194 | Disease |
| ID | Term |
|---|---|
| D017714 | Community-Acquired Infections |
| D007239 | Infections |
| D011014 | Pneumonia |
| D012141 | Respiratory Tract Infections |
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95% confidence interval of antibiotic prescription intention frequency |
| Day 0 |
| Nantes |
| 44093 |
| France |
| Poitiers University Hospital | Poitiers | 86000 | France |
| Saint-Nazaire Hospital | Saint-Nazaire | 44606 | France |
| D012140 |
| Respiratory Tract Diseases |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |