Abstract
Objective
To evaluate the diagnostic performance of chest x-ray (CXR) compared to computed tomography
(CT) for detection of pulmonary opacities in adult emergency department (ED) patients.
Methods
We conducted an observational cross-sectional study of adult patients presenting to
12 EDs in the United States from July 1, 2003, through November 30, 2006, who underwent
both CXR and chest CT for routine clinical care. CXRs and CT scans performed on the
same patient were matched. CXRs and CT scans were interpreted by attending radiologists
and classified as containing pulmonary opacities if the final radiologist report noted
opacity, infiltrate, consolidation, pneumonia, or bronchopneumonia. Using CT as a
criterion standard, the diagnostic test characteristics of CXR to detect pulmonary
opacities were calculated.
Results
The study cohort included 3423 patients. Shortness of breath, chest pain and cough
were the most common complaints, with 96.1% of subjects reporting at least one of
these symptoms. Pulmonary opacities were visualized on 309 (9.0%) CXRs and 191 (5.6
%) CT scans. CXR test characteristics for detection of pulmonary opacities included:
sensitivity 43.5% (95% CI, 36.4%-50.8%); specificity 93.0% (95% CI, 92.1%-93.9%);
positive predictive value 26.9% (95% CI, 22.1%-32.2%); and negative predictive value
96.5% (95% CI, 95.8%-97.1%).
Conclusion
In this multicenter cohort of adult ED patients with acute cardiopulmonary symptoms,
CXR demonstrated poor sensitivity and positive predictive value for detecting pulmonary
opacities. Reliance on CXR to identify pneumonia may lead to significant rates of
misdiagnosis.
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Article Info
Publication History
Published online: October 22, 2012
Accepted:
August 29,
2012
Received in revised form:
August 28,
2012
Received:
August 17,
2012
Footnotes
☆Support: (1) Supported by the National Institutes of Health ( R41HL074415 , R42HL074415 , K23HL077404 and R01HL074384 ). (2) Supported by the Office of Academic Affiliations, Department of Veterans Affairs, VA National Quality Scholars Program with resources and the use of facilities at VA Tennessee Valley Healthcare System, Nashville, TN.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
