{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T18:28:11Z","timestamp":1775932091445,"version":"3.50.1"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,3,15]],"date-time":"2025-03-15T00:00:00Z","timestamp":1741996800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,15]],"date-time":"2025-03-15T00:00:00Z","timestamp":1741996800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001779","name":"Monash University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001779","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Emerg Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>The aim of this study was to quantify the proportion of chest x-rays (CXRs) for non-traumatic chest pain (NTCP) in the emergency department (ED) that were abnormal and assess the clinical significance of these abnormalities. We also aimed to explore the variables associated with abnormal and clinically significant abnormal CXRs, to predict a population where CXRs can be safely avoided.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A single center retrospective cohort study was conducted including all adult patients presenting to a single ED with NTCP between 01 Jan 2022 and 31 Dec 2022. We categorized the CXRs into abnormal, or normal as reported by a radiologist. Abnormalities were categorized to be clinically significant based on potential or actual changes in patient management. The association of patient demographics, presenting vital signs, and clinical characteristics with clinically significant abnormalities were explored using multivariable logistic regression analysis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>There were 3,419 eligible patient encounters included for analysis. Of these, 746 (21.8%; 95%CI: 20.4-23.2%) CXRs had at least one abnormality detected. There were 218 (6.4%; 95%CI: 6.1-7.9%) CXRs deemed to have clinically significant abnormalities. Age categories of 50\u201364 years (aOR 1.64; 95%CI 1.04\u20132.60), and age\u2009&gt;\u200964 years (aOR 2.32; 95%CI: 1.51\u20133.57), history of congestive heart failure (CHF) (aOR 1.86; 95%CI: 1.08\u20133.21), smoking (aOR 1.27; 95%CI: 1.04\u20131.57), hemoptysis (aOR 6.69; 95%CI: 1.92\u201323.33), diminished lung sounds (aOR 4.87; 95%CI:2.95\u20138.05), rales (aOR 4.49; 95%CI: 2.82\u20137.15), and abnormal oxygen saturations (aOR 1.98; 95%CI: 1.40\u20132.79) were associated with clinically significant abnormalities on CXRs. In the absence of these variables, 1.4% (95%CI: 0.6-2.6%) of CXRs were abnormal with clinical significance.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>CXRs have a relatively high yield of abnormalities among patients with NTCP. However, some CXRs could be safely avoided in the absence of variables associated with clinically significant abnormalities. Further validation of these clinical characteristics is required before translation to clinical practice.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical Abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1007\/s10140-025-02329-2","type":"journal-article","created":{"date-parts":[[2025,3,15]],"date-time":"2025-03-15T02:57:51Z","timestamp":1742007471000},"page":"195-202","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluating the utility of chest x-rays for non-traumatic chest pain in Australia- a retrospective cohort study"],"prefix":"10.1007","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8741-8570","authenticated-orcid":false,"given":"Alex","family":"Lin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dinesh","family":"Varma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Biswadev","family":"Mitra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,3,15]]},"reference":[{"issue":"2","key":"2329_CR1","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1093\/fampra\/cmi124","volume":"23","author":"A Ruig\u00f3mez","year":"2006","unstructured":"Ruig\u00f3mez A, Rodr\u00edguez LA, Wallander MA, Johansson S, Jones R (2006) Chest pain in general practice: incidence, comorbidity and mortality. Fam Pract 23(2):167\u2013174","journal-title":"Fam Pract"},{"key":"2329_CR2","unstructured":"Emergency department care 2022\u20132023 data tables: Australian Institute of Health and Welfare (2024) [Available from: https:\/\/www.aihw.gov.au\/reports-data\/myhospitals\/sectors\/emergency-department-care"},{"key":"2329_CR3","unstructured":"New research Diagnosing chest pain quickly [press release]. Queensland: Emergency Medicine Foundation"},{"key":"2329_CR4","unstructured":"Chest Pain: Mayo Foundation for Medical Education and Research (2023) [Available from: https:\/\/www.mayoclinic.org\/diseases-conditions\/chest-pain\/symptoms-causes\/syc-20370838"},{"issue":"11s","key":"2329_CR5","doi-asserted-by":"crossref","first-page":"S346","DOI":"10.1016\/j.jacr.2020.09.006","volume":"17","author":"GM Beache","year":"2020","unstructured":"Beache GM, Mohammed TH, Hurwitz Koweek LM, Ghoshhajra BB, Brown RKJ, Davis AM et al (2020) ACR appropriateness Criteria\u00ae acute nonspecific chest Pain-Low probability of coronary artery disease. J Am Coll Radiol 17(11s):S346\u2013s54","journal-title":"J Am Coll Radiol"},{"issue":"5s","key":"2329_CR6","doi-asserted-by":"crossref","first-page":"S55","DOI":"10.1016\/j.jacr.2020.01.027","volume":"17","author":"JC Batlle","year":"2020","unstructured":"Batlle JC, Kirsch J, Bolen MA, Bandettini WP, Brown RKJ, Francois CJ et al (2020) ACR appropriateness Criteria\u00ae chest Pain-Possible acute coronary syndrome. J Am Coll Radiol 17(5s):S55\u2013s69","journal-title":"J Am Coll Radiol"},{"issue":"11s","key":"2329_CR7","doi-asserted-by":"crossref","first-page":"S394","DOI":"10.1016\/j.jacr.2021.08.004","volume":"18","author":"JT Stowell","year":"2021","unstructured":"Stowell JT, Walker CM, Chung JH, Bang TJ, Carter BW, Christensen JD et al (2021) ACR appropriateness Criteria\u00ae nontraumatic chest wall pain. J Am Coll Radiol 18(11s):S394\u2013s405","journal-title":"J Am Coll Radiol"},{"issue":"1","key":"2329_CR8","first-page":"e8","volume":"7","author":"E Karimi","year":"2019","unstructured":"Karimi E (2019) Comparing sensitivity of ultrasonography and plain chest radiography in detection of pneumonia; a diagnostic value study. Arch Acad Emerg Med 7(1):e8","journal-title":"Arch Acad Emerg Med"},{"issue":"3","key":"2329_CR9","doi-asserted-by":"crossref","first-page":"e190703","DOI":"10.1001\/jamanetworkopen.2019.0703","volume":"2","author":"AM Maw","year":"2019","unstructured":"Maw AM, Hassanin A, Ho PM, McInnes MDF, Moss A, Juarez-Colunga E et al (2019) Diagnostic accuracy of Point-of-Care lung ultrasonography and chest radiography in adults with symptoms suggestive of acute decompensated heart failure: A systematic review and Meta-analysis. JAMA Netw Open 2(3):e190703\u2013e","journal-title":"JAMA Netw Open"},{"issue":"10","key":"2329_CR10","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1016\/j.acra.2016.05.008","volume":"23","author":"E Fatihoglu","year":"2016","unstructured":"Fatihoglu E, Aydin S, Gokharman FD, Ece B, Kosar PN (2016) X-ray use in chest imaging in emergency department on the basis of cost and effectiveness. Acad Radiol 23(10):1239\u20131245","journal-title":"Acad Radiol"},{"issue":"5","key":"2329_CR11","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1378\/chest.10-0435","volume":"139","author":"M Zanobetti","year":"2011","unstructured":"Zanobetti M, Poggioni C, Pini R (2011) Can chest ultrasonography replace standard chest radiography for evaluation of acute dyspnea in the ED? Chest 139(5):1140\u20131147","journal-title":"Chest"},{"key":"2329_CR12","unstructured":"Biggs A Sustainable funding of healthcare: challenges ahead: Commonwealth of Australia; [Available from: https:\/\/www.aph.gov.au\/About_Parliament\/Parliamentary_Departments\/Parliamentary_Library\/pubs\/BriefingBook44p\/FundingHealthCare"},{"issue":"8","key":"2329_CR13","doi-asserted-by":"crossref","first-page":"427","DOI":"10.5694\/mja14.00472","volume":"202","author":"L Cullen","year":"2015","unstructured":"Cullen L, Greenslade J, Merollini K, Graves N, Hammett CJ, Hawkins T et al (2015) Cost and outcomes of assessing patients with chest pain in an Australian emergency department. Med J Aust 202(8):427\u2013432","journal-title":"Med J Aust"},{"key":"2329_CR14","volume-title":"Policy - Adult","author":"Royal Prince Alfred Hospital Patient Observation (Vital Signs)","year":"2010","unstructured":"Royal Prince Alfred Hospital Patient Observation (Vital Signs) (2010) Policy - Adult. Sydney South West Area Health Service, Sydney (AU)"},{"issue":"6","key":"2329_CR15","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1111\/acem.13386","volume":"25","author":"C Newsom","year":"2018","unstructured":"Newsom C, Jeanmonod R, Woolley W, Shah N, Asher S, Bruno E et al (2018) Prospective validation and refinement of a decision rule to obtain chest X-ray in patients with nontraumatic chest pain in the emergency department. Acad Emerg Med 25(6):650\u2013656","journal-title":"Acad Emerg Med"},{"issue":"2","key":"2329_CR16","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/S0736-4679(02)00499-7","volume":"23","author":"SG Rothrock","year":"2002","unstructured":"Rothrock SG, Green SM, Costanzo KA, Fanelli JM, Cruzen ES, Pagane JR (2002) High yield criteria for obtaining non-trauma chest radiography in the adult emergency department population. J Emerg Med 23(2):117\u2013124","journal-title":"J Emerg Med"},{"issue":"2","key":"2329_CR17","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1017\/S148180350001215X","volume":"12","author":"EP Hess","year":"2010","unstructured":"Hess EP, Perry JJ, Ladouceur P, Wells GA, Stiell IG (2010) Derivation of a clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome. Cjem 12(2):128\u2013134","journal-title":"Cjem"},{"issue":"SupplSuppl","key":"2329_CR18","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1016\/j.ypmed.2011.11.011","volume":"54","author":"S Prasad","year":"2012","unstructured":"Prasad S, Sung B, Aggarwal BB (2012) Age-associated chronic diseases require age-old medicine: role of chronic inflammation. Prev Med 54(SupplSuppl):S29\u201337","journal-title":"Prev Med"},{"key":"2329_CR19","unstructured":"Jones JSR, Shamsulddin A et al Heart failure (summary): Radiopaedia.org; ["},{"key":"2329_CR20","doi-asserted-by":"crossref","unstructured":"Simon AK, Hollander GA, McMichael A (2015) Evolution of the immune system in humans from infancy to old age. Proceedings of the Royal Society B: Biological Sciences.;282(1821):20143085","DOI":"10.1098\/rspb.2014.3085"},{"issue":"8","key":"2329_CR21","doi-asserted-by":"crossref","first-page":"415","DOI":"10.11622\/smedj.2016130","volume":"57","author":"ZY Ong","year":"2016","unstructured":"Ong ZY, Chai HZ, How CH, Koh J, Low TB (2016) A simplified approach to haemoptysis. Singap Med J 57(8):415\u2013418","journal-title":"Singap Med J"},{"issue":"3","key":"2329_CR22","doi-asserted-by":"crossref","first-page":"158","DOI":"10.4103\/1817-1737.160831","volume":"10","author":"M Sarkar","year":"2015","unstructured":"Sarkar M, Madabhavi I, Niranjan N, Dogra M (2015) Auscultation of the respiratory system. Ann Thorac Med 10(3):158\u2013168","journal-title":"Ann Thorac Med"},{"issue":"1","key":"2329_CR23","doi-asserted-by":"crossref","first-page":"7347","DOI":"10.1038\/s41598-020-64405-6","volume":"10","author":"L Arts","year":"2020","unstructured":"Arts L, Lim EHT, van de Ven PM, Heunks L, Tuinman PR (2020) The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis. Sci Rep 10(1):7347","journal-title":"Sci Rep"},{"issue":"4","key":"2329_CR24","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1053\/ajem.2000.7330","volume":"18","author":"WW Lee","year":"2000","unstructured":"Lee WW, Mayberry K, Crapo R, Jensen RL (2000) The accuracy of pulse oximetry in the emergency department. Am J Emerg Med 18(4):427\u2013431","journal-title":"Am J Emerg Med"},{"issue":"9","key":"2329_CR25","first-page":"E1004","volume":"19","author":"JK Poku","year":"2012","unstructured":"Poku JK, Bellamkonda-Athmaram VR, Bellolio MF, Nestler DM, Stiell IG, Hess EP (2012) Failure of prospective validation and derivation of a refined clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome. Acad Emerg Med 19(9):E1004\u2013E1010","journal-title":"Acad Emerg Med"},{"key":"2329_CR26","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.clinimag.2020.04.001","volume":"64","author":"A Jacobi","year":"2020","unstructured":"Jacobi A, Chung M, Bernheim A, Eber C (2020) Portable chest X-ray in coronavirus disease-19 (COVID-19): A pictorial review. Clin Imaging 64:35\u201342","journal-title":"Clin Imaging"},{"issue":"11","key":"2329_CR27","doi-asserted-by":"crossref","first-page":"e042946","DOI":"10.1136\/bmjopen-2020-042946","volume":"10","author":"A Borakati","year":"2020","unstructured":"Borakati A, Perera A, Johnson J, Sood T (2020) Diagnostic accuracy of X-ray versus CT in COVID-19: a propensity-matched database study. BMJ Open 10(11):e042946","journal-title":"BMJ Open"},{"key":"2329_CR28","doi-asserted-by":"crossref","unstructured":"Garin N, Marti C, Carballo S, Darbellay Farhoumand P, Montet X, Roux X et al (2019) Rational use of CT-Scan for the diagnosis of pneumonia: comparative accuracy of different strategies. J Clin Med.;8(4)","DOI":"10.3390\/jcm8040514"},{"issue":"5","key":"2329_CR29","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1136\/hrt.2005.074583","volume":"92","author":"N Mueller-Lenke","year":"2006","unstructured":"Mueller-Lenke N, Rudez J, Staub D, Laule-Kilian K, Klima T, Perruchoud AP et al (2006) Use of chest radiography in the emergency diagnosis of acute congestive heart failure. Heart 92(5):695\u2013696","journal-title":"Heart"}],"container-title":["Emergency Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10140-025-02329-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10140-025-02329-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10140-025-02329-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T04:37:42Z","timestamp":1744000662000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10140-025-02329-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,15]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["2329"],"URL":"https:\/\/doi.org\/10.1007\/s10140-025-02329-2","relation":{},"ISSN":["1438-1435"],"issn-type":[{"value":"1438-1435","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,15]]},"assertion":[{"value":"26 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 February 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 March 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors declare that no funding was received for this work.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statements and Declarations"}}]}}