{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T10:57:59Z","timestamp":1769597879816,"version":"3.49.0"},"reference-count":22,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2019,7,22]],"date-time":"2019-07-22T00:00:00Z","timestamp":1563753600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004434","name":"Universit\u00e0 degli Studi di Firenze","doi-asserted-by":"publisher","award":["16DPPN"],"award-info":[{"award-number":["16DPPN"]}],"id":[{"id":"10.13039\/501100004434","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2019,11]]},"abstract":"Abstract<\/jats:title>Objectives<\/jats:title>Guidelines recommend chest radiography (CR<\/jats:styled-content>) in the workup of suspected acute aortic syndromes (AAS<\/jats:styled-content>s) if the pretest clinical probability is low. However, the diagnostic impact of CR<\/jats:styled-content> integration for the rule\u2010in and rule\u2010out of AAS<\/jats:styled-content>s is unknown.<\/jats:p><\/jats:sec>Methods<\/jats:title>We performed a secondary analysis of the AD<\/jats:styled-content>vISED<\/jats:styled-content> multicenter study. Emergency department outpatients were eligible if an AAS<\/jats:styled-content> was clinically suspected. Clinical probability was defined with the aortic dissection detection risk score (ADD<\/jats:styled-content>\u2010RS<\/jats:styled-content>). CR<\/jats:styled-content> was evaluated blindly by a radiologist, who judged on mediastinum enlargement (ME<\/jats:styled-content>) and other signs.<\/jats:p><\/jats:sec>Results<\/jats:title>In 2014 through 2016, a total of 1,129 patients were enrolled and 1,030 were analyzed, including 48 (4.7%) with AAS<\/jats:styled-content>s. ADD<\/jats:styled-content>\u2010RS<\/jats:styled-content>\/ME<\/jats:styled-content> and ADD<\/jats:styled-content>\u2010RS<\/jats:styled-content>\/any CR<\/jats:styled-content> sign (aCR<\/jats:styled-content>s) integration were more accurate than ADD<\/jats:styled-content>\u2010RS<\/jats:styled-content> alone (area under the curve\u00a0= 0.8 and 0.78 vs. 0.66, p\u00a0<\u00a00.001). The sensitivity and specificity of the integrated strategies were 66.7% (95% confidence interval [CI<\/jats:styled-content>]\u00a0= 51.5% to 79.9%) and 82.5% (95% CI<\/jats:styled-content>\u00a0= 79.9% to 84.8%) for ADD<\/jats:styled-content>\u2010RS<\/jats:styled-content>\/ME<\/jats:styled-content> and 68.8% (95% CI<\/jats:styled-content>\u00a0= 53.6% to 80.9%) and 76.5% (95% CI<\/jats:styled-content>\u00a0= 73.7% to 79.1%) for ADD<\/jats:styled-content>\u2010RS<\/jats:styled-content>\/aCR<\/jats:styled-content>s, respectively. The sensitivity and specificity of CR<\/jats:styled-content> per se were 54.2% (95% CI<\/jats:styled-content>\u00a0= 39.2% to 68.6%) and 92.4% (95% CI<\/jats:styled-content>\u00a0= 90.5% to 93.9%) for ME<\/jats:styled-content> and 60.4% (95% CI<\/jats:styled-content>\u00a0= 45.3% to 74.2%) and 85.2% (95% CI<\/jats:styled-content>\u00a0= 82.9% to 87.4%) for aCR<\/jats:styled-content>s. The agreement (\u03ba) between attending physicians and radiologists for ME<\/jats:styled-content> was 0.44 (95% CI<\/jats:styled-content>\u00a0= 0.35 to 0.54). ADD<\/jats:styled-content>\u2010RS<\/jats:styled-content>\/ME<\/jats:styled-content> rule\u2010in (ADD<\/jats:styled-content>\u2010RS<\/jats:styled-content> \u2264 1 and ME<\/jats:styled-content>\u2010present, or ADD<\/jats:styled-content>\u2010RS<\/jats:styled-content>\u00a0>\u00a01) applied to 204 versus 130 patients with ADD<\/jats:styled-content>\u2010RS<\/jats:styled-content>\u00a0>\u00a01, including 14 with AAS<\/jats:styled-content> and 60 false\u2010positives (FP<\/jats:styled-content>). ADD<\/jats:styled-content>\u2010RS<\/jats:styled-content>\/aCR<\/jats:styled-content>s rule\u2010in (ADD<\/jats:styled-content>\u2010RS<\/jats:styled-content> \u2264 1 and aCR<\/jats:styled-content>s\u2010present, or ADD<\/jats:styled-content>\u2010RS<\/jats:styled-content>\u00a0>\u00a01) applied to 264 patients, including 15 with AAS<\/jats:styled-content> and 119 FP<\/jats:styled-content>. ADD<\/jats:styled-content>\u2010RS<\/jats:styled-content>\/ME<\/jats:styled-content> rule\u2010out (ADD<\/jats:styled-content>\u2010RS<\/jats:styled-content> \u2264 1 and ME<\/jats:styled-content>\u2010absent) applied to 826 (80.2%) patients, including 16 with AAS<\/jats:styled-content> (33.3% of cases). ADD<\/jats:styled-content>\u2010RS<\/jats:styled-content>\/aCR<\/jats:styled-content>s rule\u2010out (ADD<\/jats:styled-content>\u2010RS<\/jats:styled-content> \u2264 1 and aCR<\/jats:styled-content>s\u2010absent) applied to 766 patients (74.4%), including 15 with AAS<\/jats:styled-content> (31.3% of cases).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>CR<\/jats:styled-content> integration with clinical probability assessment showed modest rule\u2010in efficiency and insufficient sensitivity for conclusive rule\u2010out.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13819","type":"journal-article","created":{"date-parts":[[2019,6,20]],"date-time":"2019-06-20T20:37:33Z","timestamp":1561063053000},"page":"1255-1265","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Integrated Use of Conventional Chest Radiography Cannot Rule Out Acute Aortic Syndromes in Emergency Department Patients at Low Clinical Probability"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1072-9148","authenticated-orcid":false,"given":"Peiman","family":"Nazerian","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Careggi University Hospital Firenze Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuele","family":"Pivetta","sequence":"additional","affiliation":[{"name":"S.C.U. Medicina d'Urgenza Department of Emergency Medicine Molinette Hospital A.O.U. Citt\u00e0 della Salute e della Scienza Torino Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simona","family":"Veglia","sequence":"additional","affiliation":[{"name":"Radiology Department Molinette Hospital A.O.U. Citt\u00e0 della Salute e della Scienza Torino Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edoardo","family":"Cavigli","sequence":"additional","affiliation":[{"name":"Radiology Department Careggi University Hospital Firenze Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Mueller","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology University Hospital Basel University of Basel Basel Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandre","family":"de Matos Soeiro","sequence":"additional","affiliation":[{"name":"Emergency Care Unit Heart Institute University of S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5149-8764","authenticated-orcid":false,"given":"Bernd A.","family":"Leidel","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Campus Benjamin Franklin Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"Lupia","sequence":"additional","affiliation":[{"name":"S.C.U. Medicina d'Urgenza Department of Emergency Medicine Molinette Hospital A.O.U. Citt\u00e0 della Salute e della Scienza Torino Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Rutigliano","sequence":"additional","affiliation":[{"name":"Clinic of Radiology and Nuclear Medicine University Hospital of Basel Basel Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Desiree","family":"Wussler","sequence":"additional","affiliation":[{"name":"Clinic of Radiology and Nuclear Medicine University Hospital of Basel Basel Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Grifoni","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Careggi University Hospital Firenze Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7833-9632","authenticated-orcid":false,"given":"Fulvio","family":"Morello","sequence":"additional","affiliation":[{"name":"S.C.U. 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