Predictors of positive chest radiography in non-traumatic chest pain in the emergency department

ABSTRACT

To determine predictors associated with positive chest x-ray finding in patients presenting with non-traumatic chest pain in the Emergency Department [ED]. Health records, including the final radiology reports of all patients who presented with non-traumatic chest pain and had a chest x-ray performed in an urban Canadian tertiary care ED over four consecutive months were reviewed Demographic and clinical variables were also extracted Chest x-ray findings were categorized as normal [either normal or no significant change from previous x-rays] or abnormal* Descriptive statistics were used to describe the data Multivariable logistic regression was used to determine the association between various predictors and chest x-ray finding [positive/negative]. The 330 study patients had the following characteristics mean age 58 +/- 20 years; female 41% [n=134] Patients' chief complaints were only chest pain 75% [n=248], chest pain with shortness of breath 12% [n=41], chest pain with palpitation 4% [n=14], chest pain with other complaints 9% [n=28] Chest x-rays were reported as normal or no acute changes in 81% [n=266] of patients, and abnormal in 19% [n=64] of patients* The most common abnormal chest x-ray diagnoses were congestive heart failure [n=28; 8%] and pneumonia [n=17; 5%] Those with abnormal chest x-ray findings were significantly older [71 versus 55 years; p<0.001], had chest pain with shortness of breath [36% versus 11%; p<0.001], had significant past medical history [39% versus 14%; p<0.001], and were also tachypnoic [31% versus 12%; p<0.001]. This study found that patients with non-traumatic chest pain are likely to have a normal chest x-ray if they were young, not tachypnoeic or short of breath, and had no significant past medical history. A larger study is required to confirm these findings: