Evaluation of the impact of Ultra Low Dose Chest Computed Tomography in the management of patients with suspected community-acquired pneumonia

Abstract

It's known that the indiscriminate use of antibiotics nowadays is leading to high rate of bacterial resistance.The rescription of this kind of medicine for diseases not caused by bacterial infection is a common cause of resistance, especially viral acheobronquitis. It's also known of the difficult by non-radiologist physicians to make a certain diagnosis using chest x-ray on the emergency department (ED), leading to wrongly prescription of antibiotics for viral infections. Computed Tomography (CT) is known to be the gold standard method to evaluate inferior airways infection, but the radiation dose is higher than chest x-ray. The ultralow dose computed tomography of the chest (ULDCT) is a new method os CT using new technology of reconstruction of the imagens leading to lower radiation doses. We believe the use of ultralow dose computed tomography of the chest (ULDCT) in the handling of patients with suspect of inferior airways infection on the ED may lead to less antibiotics prescription. This question isn't answered yet. Methods - A prospective study using adult patients, age 18-60, from to two distinct ED of Hospital Israelita Albert Einstein of São Paulo from September 2016 to June of 2017 with inferior airways infection complain. We'll choose randomly some patients to be conducted with the regular clinical care and another group of patients using ULDCT of chest. The regular routine clinical care uses the chest x-ray with front and perfil projections with interpretation of the emergency clinician. The group using ULDCT have theirs CTs reviewed by an emergency radiologist with at least one year experience. Later we will review the prescription of antibiotics in both groups and all patients will be contacted at 4, 15 and 30 days after randomization to assess study outcomes and will be survey with the use of a detailed structured interview regarding their health and all encounters they had with health care providers after randomization. Studies had shown that computed tomography (CT) is the best method to evaluate inferior airways infections. So, we believe, the use of ULDCT at the ED will increase the accuracy the detection of inferior airways infection and consequently less unnecessary antibiotics prescription, without raise the total radiation dose in these patients. (AU)