Guidelines for the selective ordering of admission chest radiography in adult obstructive airway disease

Timothy Wei Tsai, E. John Gallagher, Gary Lombardi, Paul Gennis, Wallace Carter

Research output: Contribution to journalArticlepeer-review

60 Scopus citations


Study objective: To validate previously developed guidelines for the selective use of chest radiography in adults admitted for exacerbation of obstructive airway disease. Design: Prospective, observational cohort study using criteria developed in a previous retrospective study. Participants: Unselected convenience sample of 128 adults with obstructive airway disease who did not respond to standard emergency department treatment and required admission. Setting: Municipal hospital ED and inpatient medical service. Interventions: 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). Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)1854-1858
Number of pages5
JournalAnnals of emergency medicine
Issue number12
StatePublished - Dec 1993
Externally publishedYes


  • asthma
  • chest radiography
  • obstructive airway disease

ASJC Scopus subject areas

  • Emergency Medicine


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