title: Guidelines for the selective ordering of admission chest radiography in adult obstructive airway disease.
abstract: OBJECTIVE
  To validate previously developed guidelines for the selective use of chest radiography in adults admitted for exacerbation of obstructive airway disease.
  
  
  METHODS
  Prospective, observational cohort study using criteria developed in a previous retrospective study.
  
  
  METHODS
  Unselected convenience sample of 128 adults with obstructive airway disease who did not respond to standard emergency department treatment and required admission.
  
  
  METHODS
  Municipal hospital ED and inpatient medical service.
  
  
  METHODS
  Patients were categorized as "complicated" or "uncomplicated" according to previously developed criteria. Management was recorded as altered if the patient's physician answered the question, "Did the chest radiography alter your management of this patient?" affirmatively.
  
  
  RESULTS
  Of 27 patients whose management was altered by the chest radiography, 26 were classified as complicated, for a sensitivity of 96% (95% confidence interval [CI], 81, 100). One of 44 admissions classified as uncomplicated had management altered by the chest radiography (negative predictive value, 98%, 95% CI, 88, 100). This chest radiography was later reread as normal. Classification as an uncomplicated patient with obstructive airway disease was strongly associated with either a normal chest radiography or a radiographic finding that was clinically unimportant (P = .0002).
  
  
  CONCLUSIONS
  Patients with acute exacerbation of obstructive airway disease who are otherwise uncomplicated do not benefit from routine admission chest radiography. The use of this simple clinical strategy would safely reduce the number of chest radiographs by about one-third in this and similar patient populations, decreasing both health care costs and exposure to ionizing radiation.
authors.affiliation: Emergency Department, Bronx Municipal Hospital, New York.
authors.forename: T W
authors.initials: TW
authors.lastname: Tsai
authors.forename: E J
authors.initials: EJ
authors.lastname: Gallagher
authors.forename: G
authors.initials: G
authors.lastname: Lombardi
authors.forename: P
authors.initials: P
authors.lastname: Gennis
authors.forename: W
authors.initials: W
authors.lastname: Carter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000000981:diagnostic imaging* / Q000628:therapy; D003955:Diagnostic Tests, Routine / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006773:Hospitals, Municipal / Q000592:standards*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008173:Lung Diseases, Obstructive / Q000000981:diagnostic imaging* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009519:New York City; D010343:Patient Admission; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000592:standards / Q000706:statistics & numerical data