Abstract
In this issue, Collins et al present data from the Acute Decompensated Heart Failure Registry (ADHERE) and suggest that the initial emergency department (ED) chest radiograph may be insensitive to predict a hospital discharge diagnosis of acutely decompensated heart failure. The assertion that the chest radiograph is not that sensitive (for many disorders) is not new; however, the idea that 1 in 5 congestive heart failure patients has a false-negative chest radiograph in the ED seems inconsistent with clinical practice. If the chest radiograph does not show signs of heart failure, are we really missing clinically important cases? The face validity of these conclusions seems incongruent with our practice. Either the results are correct and we have been wrong in a number of cases for many years, or the data and assumptions used by Collins et al to infer these conclusions are invalid. I will make an argument for why the latter is likely true.
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