Table of Contents
Advances in Emergency Medicine
Volume 2014, Article ID 241935, 5 pages
http://dx.doi.org/10.1155/2014/241935
Research Article

Validation of a Decision Rule and Derivation of a Modified Rule to Obtain Chest Radiograph in Patients with Nontraumatic Chest Pain in the Emergency Department

1St. Luke’s University Hospital and Health Network, Department of Emergency Medicine, Bethlehem, PA 610-954-1102, USA
2University of Tennessee School of Medicine, Middle Tennessee Emergency Physicians, PC, 1 Vantage Way No. B240, Nashville, TN 37228-1562, USA

Received 2 March 2014; Revised 19 May 2014; Accepted 27 May 2014; Published 12 June 2014

Academic Editor: Bruno Megarbane

Copyright © 2014 Case Newsom et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives. We sought to validate and refine a decision rule for chest X-ray (CXR) utilization in nontraumatic chest pain (CP) patients presenting to the emergency department (ED). Methods. Retrospective review of ED patients presenting with CP who had CXR performed during three nonconsecutive months was performed. The presence of 18 variables derived from history and exam was ascertained. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the original rule were calculated. Refinement using additional variables was performed. Results. 967 patient charts were reviewed. 89.9% of CXR were normal, 5.2% had insignificant findings, and 5.1% had significant findings. Application of the criteria had a sensitivity/specificity of 74%/59% and a PPV/ NPV of 9%/98%. Rule modification to obtain CXR for age ≥ 65 years, history of congestive heart failure and alcohol abuse, and exam findings of decreased breath sounds, fever, and tachypnea maintained sensitivity while improving specificity to 69%. Conclusions. Most CP patients have normal CXRs. Narrowing a decision rule to obtain CXR in patients with age ≥ 65 years, history of congestive heart failure and alcohol abuse, and exam findings of decreased breath sounds, fever, and tachypnea maintain sensitivity while improving specificity and NPV.