High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients

Implications for diagnosing pneumonia

Wesley H. Self*, D Mark Courtney, Candace D. McNaughton, Richard G Wunderink, Jeffrey A. Kline

*Corresponding author for this work

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Objective: To evaluate the diagnostic performance of chest x-ray (CXR) compared to computed tomography (CT) for detection of pulmonary opacities in adult emergency department (ED) patients. Methods: We conducted an observational cross-sectional study of adult patients presenting to 12 EDs in the United States from July 1, 2003, through November 30, 2006, who underwent both CXR and chest CT for routine clinical care. CXRs and CT scans performed on the same patient were matched. CXRs and CT scans were interpreted by attending radiologists and classified as containing pulmonary opacities if the final radiologist report noted opacity, infiltrate, consolidation, pneumonia, or bronchopneumonia. Using CT as a criterion standard, the diagnostic test characteristics of CXR to detect pulmonary opacities were calculated. Results: The study cohort included 3423 patients. Shortness of breath, chest pain and cough were the most common complaints, with 96.1% of subjects reporting at least one of these symptoms. Pulmonary opacities were visualized on 309 (9.0%) CXRs and 191 (5.6 %) CT scans. CXR test characteristics for detection of pulmonary opacities included: sensitivity 43.5% (95% CI, 36.4%-50.8%); specificity 93.0% (95% CI, 92.1%-93.9%); positive predictive value 26.9% (95% CI, 22.1%-32.2%); and negative predictive value 96.5% (95% CI, 95.8%-97.1%). Conclusion: In this multicenter cohort of adult ED patients with acute cardiopulmonary symptoms, CXR demonstrated poor sensitivity and positive predictive value for detecting pulmonary opacities. Reliance on CXR to identify pneumonia may lead to significant rates of misdiagnosis.

Original languageEnglish (US)
Pages (from-to)401-405
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume31
Issue number2
DOIs
StatePublished - Feb 1 2013

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Hospital Emergency Service
Pneumonia
Thorax
Tomography
X-Rays
Lung
Bronchopneumonia
Diagnostic Errors
Chest Pain
Routine Diagnostic Tests
Cough
Dyspnea
Cohort Studies
Cross-Sectional Studies

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

@article{70524a1e3e064d8d93a580bc96c2688a,
title = "High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients: Implications for diagnosing pneumonia",
abstract = "Objective: To evaluate the diagnostic performance of chest x-ray (CXR) compared to computed tomography (CT) for detection of pulmonary opacities in adult emergency department (ED) patients. Methods: We conducted an observational cross-sectional study of adult patients presenting to 12 EDs in the United States from July 1, 2003, through November 30, 2006, who underwent both CXR and chest CT for routine clinical care. CXRs and CT scans performed on the same patient were matched. CXRs and CT scans were interpreted by attending radiologists and classified as containing pulmonary opacities if the final radiologist report noted opacity, infiltrate, consolidation, pneumonia, or bronchopneumonia. Using CT as a criterion standard, the diagnostic test characteristics of CXR to detect pulmonary opacities were calculated. Results: The study cohort included 3423 patients. Shortness of breath, chest pain and cough were the most common complaints, with 96.1{\%} of subjects reporting at least one of these symptoms. Pulmonary opacities were visualized on 309 (9.0{\%}) CXRs and 191 (5.6 {\%}) CT scans. CXR test characteristics for detection of pulmonary opacities included: sensitivity 43.5{\%} (95{\%} CI, 36.4{\%}-50.8{\%}); specificity 93.0{\%} (95{\%} CI, 92.1{\%}-93.9{\%}); positive predictive value 26.9{\%} (95{\%} CI, 22.1{\%}-32.2{\%}); and negative predictive value 96.5{\%} (95{\%} CI, 95.8{\%}-97.1{\%}). Conclusion: In this multicenter cohort of adult ED patients with acute cardiopulmonary symptoms, CXR demonstrated poor sensitivity and positive predictive value for detecting pulmonary opacities. Reliance on CXR to identify pneumonia may lead to significant rates of misdiagnosis.",
author = "Self, {Wesley H.} and Courtney, {D Mark} and McNaughton, {Candace D.} and Wunderink, {Richard G} and Kline, {Jeffrey A.}",
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High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients : Implications for diagnosing pneumonia. / Self, Wesley H.; Courtney, D Mark; McNaughton, Candace D.; Wunderink, Richard G; Kline, Jeffrey A.

In: American Journal of Emergency Medicine, Vol. 31, No. 2, 01.02.2013, p. 401-405.

Research output: Contribution to journalArticle

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N2 - Objective: To evaluate the diagnostic performance of chest x-ray (CXR) compared to computed tomography (CT) for detection of pulmonary opacities in adult emergency department (ED) patients. Methods: We conducted an observational cross-sectional study of adult patients presenting to 12 EDs in the United States from July 1, 2003, through November 30, 2006, who underwent both CXR and chest CT for routine clinical care. CXRs and CT scans performed on the same patient were matched. CXRs and CT scans were interpreted by attending radiologists and classified as containing pulmonary opacities if the final radiologist report noted opacity, infiltrate, consolidation, pneumonia, or bronchopneumonia. Using CT as a criterion standard, the diagnostic test characteristics of CXR to detect pulmonary opacities were calculated. Results: The study cohort included 3423 patients. Shortness of breath, chest pain and cough were the most common complaints, with 96.1% of subjects reporting at least one of these symptoms. Pulmonary opacities were visualized on 309 (9.0%) CXRs and 191 (5.6 %) CT scans. CXR test characteristics for detection of pulmonary opacities included: sensitivity 43.5% (95% CI, 36.4%-50.8%); specificity 93.0% (95% CI, 92.1%-93.9%); positive predictive value 26.9% (95% CI, 22.1%-32.2%); and negative predictive value 96.5% (95% CI, 95.8%-97.1%). Conclusion: In this multicenter cohort of adult ED patients with acute cardiopulmonary symptoms, CXR demonstrated poor sensitivity and positive predictive value for detecting pulmonary opacities. Reliance on CXR to identify pneumonia may lead to significant rates of misdiagnosis.

AB - Objective: To evaluate the diagnostic performance of chest x-ray (CXR) compared to computed tomography (CT) for detection of pulmonary opacities in adult emergency department (ED) patients. Methods: We conducted an observational cross-sectional study of adult patients presenting to 12 EDs in the United States from July 1, 2003, through November 30, 2006, who underwent both CXR and chest CT for routine clinical care. CXRs and CT scans performed on the same patient were matched. CXRs and CT scans were interpreted by attending radiologists and classified as containing pulmonary opacities if the final radiologist report noted opacity, infiltrate, consolidation, pneumonia, or bronchopneumonia. Using CT as a criterion standard, the diagnostic test characteristics of CXR to detect pulmonary opacities were calculated. Results: The study cohort included 3423 patients. Shortness of breath, chest pain and cough were the most common complaints, with 96.1% of subjects reporting at least one of these symptoms. Pulmonary opacities were visualized on 309 (9.0%) CXRs and 191 (5.6 %) CT scans. CXR test characteristics for detection of pulmonary opacities included: sensitivity 43.5% (95% CI, 36.4%-50.8%); specificity 93.0% (95% CI, 92.1%-93.9%); positive predictive value 26.9% (95% CI, 22.1%-32.2%); and negative predictive value 96.5% (95% CI, 95.8%-97.1%). Conclusion: In this multicenter cohort of adult ED patients with acute cardiopulmonary symptoms, CXR demonstrated poor sensitivity and positive predictive value for detecting pulmonary opacities. Reliance on CXR to identify pneumonia may lead to significant rates of misdiagnosis.

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