Tw. Tsai et al., GUIDELINES FOR THE SELECTIVE ORDERING OF ADMISSION CHEST RADIOGRAPHY IN ADULT OBSTRUCTIVE AIRWAY DISEASE, Annals of emergency medicine, 22(12), 1993, pp. 1854-1858
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.