{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T05:30:02Z","timestamp":1778131802921,"version":"3.51.4"},"reference-count":16,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,5,16]],"date-time":"2018-05-16T00:00:00Z","timestamp":1526428800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2018,6]]},"abstract":"Abstract<\/jats:title>Objectives<\/jats:title>The objective was to prospectively validate and refine previously published criteria to determine the potential utility of chest x\u2010ray (CXR<\/jats:styled-content>) in the evaluation and management of patients presenting to the emergency department (ED<\/jats:styled-content>) with nontraumatic chest pain (CP<\/jats:styled-content>).<\/jats:p><\/jats:sec>Methods<\/jats:title>A prospective observational study was performed of patients presenting to three ED<\/jats:styled-content>s in the United States with a chief complaint of nontraumatic CP<\/jats:styled-content>. Previously defined high\u2010risk history and examination elements were combined into a refined decision rule and these elements were recorded for each patient by the ED<\/jats:styled-content> physician. CXR<\/jats:styled-content> results were reviewed and analyzed to determine the presence of clinically significant findings including pneumonia, pleural effusion, pneumothorax, congestive heart failure, or the presence of a new mass. Odds ratios for each history and examination element were analyzed as well as sensitivity, specificity, and negative predictive value (NPV<\/jats:styled-content>) of the rule overall.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 1,111 patients were enrolled and 1,089 CXR<\/jats:styled-content>s were analyzed. There were 70 (6.4%) patients with clinically relevant findings on CXR<\/jats:styled-content>. The refined decision rule had a sensitivity of 92.9% (confidence interval [CI<\/jats:styled-content>]\u00a0= 83.4%\u201397.3%) and specificity of 30.4% (CI<\/jats:styled-content>\u00a0= 27.6%\u201333.4%) to predict clinically relevant findings on CXR<\/jats:styled-content>, with a NPV<\/jats:styled-content> of 98.4% (CI<\/jats:styled-content>\u00a0= 96.1%\u201399.4%). Five CXR<\/jats:styled-content>s with clinically significant findings would have been missed by application of the refined rule (three pneumonias and two pleural effusions). Applying these criteria as a CXR<\/jats:styled-content> decision rule to this population would have reduced CXR<\/jats:styled-content> utilization by 28.9%.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>This study validates previous research suggesting a low clinical yield for CXR<\/jats:styled-content> in the setting of nontraumatic CP<\/jats:styled-content> in the ED<\/jats:styled-content>. This refined clinical decision rule has a favorable sensitivity and NPV<\/jats:styled-content> in a patient population with low incidence of disease. Further validation is needed prior to use in practice.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13386","type":"journal-article","created":{"date-parts":[[2018,2,10]],"date-time":"2018-02-10T09:52:41Z","timestamp":1518256361000},"page":"650-656","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Prospective Validation and Refinement of a Decision Rule to Obtain Chest X\u2010ray in Patients With Nontraumatic Chest Pain in the Emergency Department"],"prefix":"10.1111","volume":"25","author":[{"given":"Case","family":"Newsom","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine St. Luke's University Health Network Bethlehem PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Jeanmonod","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine St. Luke's University Health Network Bethlehem PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy","family":"Woolley","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Virginia Tech Carilion School of Medicine Roanoke VA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nirali","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Tennessee Health Science Center Murfreesboro TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shellie","family":"Asher","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albany Medical Center Albany NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Bruno","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Tennessee Health Science Center Murfreesboro TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Silberman","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Tennessee Health Science Center Murfreesboro TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Reiter","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Tennessee Health Science Center Murfreesboro TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald","family":"Jeanmonod","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine St. Luke's University Health Network Bethlehem PA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,5,16]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"RuiP KangK.National Hospital Ambulatory Medical Care Survey: 2014 emergency Department Summary Tables. 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