TY - JOUR T1 - Ultra-low-dose CT versus chest X-ray for patients suspected of pulmonary disease at the emergency department: a multicentre randomised clinical trial JF - Thorax JO - Thorax SP - 515 LP - 522 DO - 10.1136/thoraxjnl-2021-218337 VL - 78 IS - 5 AU - Inge A H van den Berk AU - Maadrika M N P Kanglie AU - Tjitske S R van Engelen AU - Josje Altenburg AU - Jouke T Annema AU - Ludo F M Beenen AU - Bart Boerrigter AU - Marije K Bomers AU - Paul Bresser AU - Elvin Eryigit AU - Maarten Groenink AU - Suzanne M R Hochheimer AU - Frits Holleman AU - Jos A J Kooter AU - Ramon B van Loon AU - Mitran Keijzers AU - Ivo van der Lee AU - Paul Luijendijk AU - Lilian J Meijboom AU - Saskia Middeldorp AU - Laura J Schijf AU - Robin Soetekouw AU - Ralf W Sprengers AU - Alexander D Montauban van Swijndregt AU - Wouter de Monyé AU - Milan L Ridderikhof AU - Michiel M Winter AU - Shandra Bipat AU - Marcel G W Dijkgraaf AU - Patrick M M Bossuyt AU - Jan M Prins AU - Jaap Stoker A2 - , Y1 - 2023/05/01 UR - http://thorax.bmj.com/content/78/5/515.abstract N2 - Background Chest CT displays chest pathology better than chest X-ray (CXR). We evaluated the effects on health outcomes of replacing CXR by ultra-low-dose chest-CT (ULDCT) in the diagnostic work-up of patients suspected of non-traumatic pulmonary disease at the emergency department.Methods Pragmatic, multicentre, non-inferiority randomised clinical trial in patients suspected of non-traumatic pulmonary disease at the emergency department. Between 31 January 2017 and 31 May 2018, every month, participating centres were randomly allocated to using ULDCT or CXR. Primary outcome was functional health at 28 days, measured by the Short Form (SF)-12 physical component summary scale score (PCS score), non-inferiority margin was set at 1 point. Secondary outcomes included hospital admission, hospital length of stay (LOS) and patients in follow-up because of incidental findings.Results 2418 consecutive patients (ULDCT: 1208 and CXR: 1210) were included. Mean SF-12 PCS score at 28 days was 37.0 for ULDCT and 35.9 for CXR (difference 1.1; 95% lower CI: 0.003). After ULDCT, 638/1208 (52.7%) patients were admitted (median LOS of 4.8 days; IQR 2.1–8.8) compared with 659/1210 (54.5%) patients after CXR (median LOS 4.6 days; IQR 2.1–8.8). More ULDCT patients were in follow-up because of incidental findings: 26 (2.2%) versus 4 (0.3%).Conclusions Short-term functional health was comparable between ULDCT and CXR, as were hospital admissions and LOS, but more incidental findings were found in the ULDCT group. Our trial does not support routine use of ULDCT in the work-up of patients suspected of non-traumatic pulmonary disease at the emergency department.Trial registration number NTR6163.Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The data that support the findings of this study are available from the corresponding author, IAHvdB, upon reasonable request. ER -