215 REDUCE ACP Study: Radiographs in the Emergency Department Utilization Criteria Evaluation - Adult Chest Pain

Abstract

Study ObjectivesTo begin development of a decisionmaking tool that will allow emergency physicians to selectively obtain chest x-rays (CXR) in adults presenting with nontraumatic chest pain.MethodsWe performed a retrospective cohort study of 567 consecutive adult patients with a chief complaint of chest pain who had CXR performed during their ED evaluation. All positive CXR findings were assessed for clinical significance defined as a finding which would change the disposition, treatment, or follow-up of the patient. We then evaluated each chart for historical elements and physical exam findings that might identify criteria associated with positive radiographic findings in order to propose a set of criteria which could lead to the development and validation of a decision rule with a high sensitivity for clinically significant findings on chest x-ray.ResultsOnly 5% (n=27) of 567 patients had a CXR finding that was clinically significant. The criteria which would have identified all but 1 patient with a positive CXR were abnormal vital signs, smoking history, pleuritic chest pain, cough, and abnormal breath sounds. The sole patient not identified by these criteria was found to have a disrupted AICD lead. Since implanted devices are an independent indication for imaging, these patients may need to be excluded from future rule development.ConclusionTabled 1 Study ObjectivesTo begin development of a decisionmaking tool that will allow emergency physicians to selectively obtain chest x-rays (CXR) in adults presenting with nontraumatic chest pain. To begin development of a decisionmaking tool that will allow emergency physicians to selectively obtain chest x-rays (CXR) in adults presenting with nontraumatic chest pain. MethodsWe performed a retrospective cohort study of 567 consecutive adult patients with a chief complaint of chest pain who had CXR performed during their ED evaluation. All positive CXR findings were assessed for clinical significance defined as a finding which would change the disposition, treatment, or follow-up of the patient. We then evaluated each chart for historical elements and physical exam findings that might identify criteria associated with positive radiographic findings in order to propose a set of criteria which could lead to the development and validation of a decision rule with a high sensitivity for clinically significant findings on chest x-ray. We performed a retrospective cohort study of 567 consecutive adult patients with a chief complaint of chest pain who had CXR performed during their ED evaluation. All positive CXR findings were assessed for clinical significance defined as a finding which would change the disposition, treatment, or follow-up of the patient. We then evaluated each chart for historical elements and physical exam findings that might identify criteria associated with positive radiographic findings in order to propose a set of criteria which could lead to the development and validation of a decision rule with a high sensitivity for clinically significant findings on chest x-ray. ResultsOnly 5% (n=27) of 567 patients had a CXR finding that was clinically significant. The criteria which would have identified all but 1 patient with a positive CXR were abnormal vital signs, smoking history, pleuritic chest pain, cough, and abnormal breath sounds. The sole patient not identified by these criteria was found to have a disrupted AICD lead. Since implanted devices are an independent indication for imaging, these patients may need to be excluded from future rule development. Only 5% (n=27) of 567 patients had a CXR finding that was clinically significant. The criteria which would have identified all but 1 patient with a positive CXR were abnormal vital signs, smoking history, pleuritic chest pain, cough, and abnormal breath sounds. The sole patient not identified by these criteria was found to have a disrupted AICD lead. Since implanted devices are an independent indication for imaging, these patients may need to be excluded from future rule development. ConclusionTabled 1