EVALUATION OF HIGH-YIELD CRITERIA FOR CHEST RADIOGRAPHY IN ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

Study objectives: The objectives of this study were to assess the incidence of abnormal chest radiographs and to test the validity of previously developed high-yield criteria. There is disagreement about the need for chest radiography in acute exacerbation of chronic obstructive pulmonary disease, although high-yield criteria have been developed. Design: Retrospective chart review study. Setting: County-owned, university-affiliated, urban emergency department. Participants: ED patients seen between January 1988 and July 1991 with chronic obstructive pulmonary disease. Results: Eight hundred forty-seven ED visits were identified; medical records were available for 742. Radiographs were not taken in 8%, leaving 685 ED visits in the study. One hundred nine patients (16%) had significant abnormalities, including 88 new infiltrates, two new lung masses, one pneumothorax, and 20 episodes of pulmonary edema. A history of congestive heart failure and fever was associated with abnormalities, as were findings of rales, pedal edema, and jugular venous distension. There was no association with WBC count, temperature, coronary artery disease, chest pain, or sputum production. Previously published high-yield criteria had a sensitivity of .76; specificity, .41; positive predictive value, .20; negative predictive value, .90; and accuracy, .47. Conclusion: Radiographic abnormalities are common findings in acute exacerbation of chronic obstructive pulmonary disease. We found that almost one fourth of radiographic abnormalities are not predictable on the basis of previously developed high-yield criteria. Routine chest radiography should be considered in patients with acute exacerbation of chronic obstructive pulmonary disease to diagnose treatable, radiographically apparent abnormalities.