GUIDELINES FOR THE SELECTIVE ORDERING OF ADMISSION CHEST RADIOGRAPHY IN ADULT OBSTRUCTIVE AIRWAY DISEASE

Study objective: To validate previously developed guidelines for the s elective use of chest radiography in adults admitted for exacerbation of obstructive airway disease. Design: Prospective, observational coho rt study using criteria developed in a previous retrospective study. P articipants: Unselected convenience sample of 128 adults with obstruct ive airway disease who did not respond to standard emergency departmen t treatment and required admission. Setting: Municipal hospital ED and inpatient medical service. Interventions: Patients were categorized a s ''complicated' or ''uncomplicated' according to previously developed criteria. Management was recorded as altered if the patient's physici an answered the question, ''Did the chest radiography alter your manag ement of this patient?'' affirmatively. Results: Of 27 patients whose management was altered by the chest radiography, 26 were classified as complicated, for a sensitivity of 96% (95% confidence interval [Cl], 81, 100). One of 44 admissions classified as uncomplicated had managem ent altered by the chest radiography (negative predictive value, 98%; 95% Cl, 88, 100). This chest radiography was later reread as normal. C lassification as an uncomplicated patient with obstructive airway dise ase was strongly associated with either a normal chest radiography or a radiographic finding that was clinically unimportant (P=.0002). Conc lusion: Patients with acute exacerbation of obstructive airway disease who are otherwise uncomplicated do not benefit from routine admission chest radiography. The use of this simple clinical strategy would saf ely reduce the number of chest radiographs by about one-third in this and similar patient populations, decreasing both health care costs and exposure to ionizing radiation.