Keywords
chest X-ray
emergency service
relevance
How to Cite
Abstract
Background: Chest pain is a frequent reason of consultation in emergency department (ED). Despite the lack of recommendations, chest X-ray (CXR) is often performed in this context.
Methods: This is a single-center retrospective study. From September to November 2012, adult patients admitted to ED with chest pain were included in the study. CXR and patients characteristics were analyzed. An expert committee was in charge to determine if the realization of the CXR was useful or not.
Results: Of the 300 patients who consulted in our Ed for chest pain, CXR were performed for 71% (N = 205) of them. Twenty percent (N = 40) of CXRs were interpreted as pathological. Radiological confirmation rate for the initial medical hypothesis was 12% (N = 24). Our expert committee judged 92% (N = 188) of the CXR was relevant. Discordances between experts were observed for 20 medical records (kappa test = 0.109). In multivariate analysis, variables associated with abnormal CXR were: presence of one or more cardio-vascular risk factor (p = 0.05), clinical exam abnormalities (dyspnea, caught, pulmonary exam abnormalities) (p = 0.006) and laboratory abnormalities (troponin, D-dimers, CRP, and white blood cells) (p = 0.016).
Conclusions: One CXR of five find abnormalities. Experts judged relevant for nine cases of ten with a low level of concordance. The absence of dyspnea, fever, cough, auscultatory abnormalities, and biological inflammatory reaction are independent criteria of normal CXR. Pulmonary ultrasound and guidelines could help to optimize practices.
References
Lee TH, Cook EF, Weisberg M, Sargent RK, Wilson C, Goldman L. Acute chest pain in the emergency room. Identification and examination of low-risk patients. Arch Intern Med 1985; 145:65-9.
Fruergaard P, Launbjerg J, Hesse B, Jørgensen F, Petri A, Eiken P, et al. The diagnoses of patients admitted with acute chest pain but without myocardial infarction. Eur Heart J 1996; 17:1028-34.
Erhardt L, Herlitz J, Bossaert L, Halinen M, Keltai M, Koster R, et al. Task force on the management of chest pain. Eur Heart J 2002; 23:1153-76.
Carbonneil C. Quelles indications aujourd’hui pour la radio du thorax? HAS 2009.
Raphaël M, Valéri M.L. Prise en charge d’une douleur thoracique aux urgences. EMC – Médecine Urgence 2007; 25:1-21.
Mayaud C, Saidi F, Parrot A. Place de la radiographie de thorax pour la prise en charge des pneumonies communautaires. Rev Pneumol Clin 1999; 55:373-91.
Russell NJ, Pantin CF, Emerson PA, Crichton NJ. The role of chest radiography in patients presenting with anterior chest pain to the Accident & Emergency Department. J R Soc Med 1988; 81:626-8.
Institut de veille sanitaire de radioprotection et de sûreté nucléaire (France). Exposition de la population française aux rayonnements ionisants liée aux actes de diagnostic médical en 2007. Institut de veille sanitaire 2010.
Mathews JD, Forsythe AV, Brady Z, Butler MW, Goergen SK, Byrnes GB, et al. Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ 2013; 346:f2360.
Rohner DJ, Bennett S, Samaratunga C, Jewell ES, Smith JP, Gaskill-Shipley M, et al. Cumulative total effective whole body radiation dose in critically- ill patients. Chest. 2013; 144:1481-6.
Claus EB, Calvocoressi L, Bondy ML, Schildkraut JM, Wiemels JL, Wrensch M. Dental x-rays and risk of meningioma. Cancer 2012; 118:4530-7.
Shah DJ, Sachs RK, Wilson DJ. Radiation-induced cancer: a modern view. Br J Radiol 2012; 85:e1166-73.
Jesse RL, Kontos MC. Evaluation of chest pain in the emergency department. Curr Probl Cardiol 1997; 22:149-236.
Lee TH, Goldman L. Evaluation of the patient with acute chest pain. N Engl J Med 2000; 342:1187-95.
Campione KM. Cardiovascular chest pain as an emergency situation. J Lancet 1964; 84:213-23.
Aronchick J, Epstein D, Gefter WB, Miller WT. Evaluation of the chest radiograph in the emergency department patient. Emerg Med Clin North Am 1985; 3:491-505.
Clinton JE, Yaron M, Tsai SH. Chest radiography in the emergency department. Ann Emerg Med 1986; 15:254-6.
Samad Z, Hakeem A, Mahmood SS, Pieper K, Patel MR, Simel DL, Douglas PS. A meta-analysis and systematic review of computed tomography angiography as a diagnostic triage tool for patients with chest pain presenting to the emergency department. J Nucl Cardiol 2012; 19:364-76.
Dedic A, Genders TS, Nieman K, Hunink MG. Imaging strategies for acute chest pain in the emergency department. Am J Roentgenol 2013; 200:W26-38.
Templeton P, McCallion W, McKinney L, Wilson H. Chest pain in the accident and emergency department: is chest radiography worthwhile? Arch Emerg Med 199; 8:97-101.
Rothrock SG, Green SM, Costanzo KA, Fanelli J-M, Cruzen ES, Pagane JR. High yield criteria for obtaining non-trauma chest radiography in the adult emergency department population. J Emerg Med 2002; 23:117-24.
Greenslade JH, Beamish D, Parsonage W, Hawkins T, Schluter J, Dalton E, et al. Relationship between physiological parameters and acute coronary syndrome in patients presenting to the emergency department with undifferentiated chest pain. J Cardiovasc Nurs 2015; 31:267-73.
Visser A, Wolthuis A, Breedveld R, TerAvest E. HEART score and clinical gestalt have similar diagnostic accuracy for diagnosing ACS in an unselected population of patients with chest pain presenting in the ED. Emerg Med J 2015; 32:595-600.
Targhetta R, Bourgeois JM, Balmes P. Echography of pneumothorax. Rev Mal Respir 1990; 7:575-9.
Alrajhi K, Woo MY, Vaillancourt C. Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest 2012; 141:703-8.
Bourcier JE, Paquet J, Seinger M, Gallard E, Redonnet JP, Cheddadi F, et al. Performance comparison of lung ultrasound and chest x-ray for the diagnosis of pneumonia in the ED. Am J Emerg Med 2014; 32:115-8.
Bobbia X, Hansel N, Muller L, Claret PG, Moreau A, Genre Grandpierre R, eta l. Availability and practice of bedside ultrasonography in emergency rooms and prehospital setting: a French survey. Ann Fr Anesth Reanim 2014; 33:e29-33.