False-negative chest radiographs in emergency department diagnosis of pneumonia

Brandon C. Maughan; Nicholas Asselin; Jennifer L. Carey; Andrew Sucov; Jonathan H. Valente

False-negative chest radiographs in emergency department diagnosis of pneumonia

Brandon C. Maughan, Nicholas Asselin, Jennifer L. Carey, Andrew Sucov, Jonathan H. Valente

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Emergency department (ED) patients frequently undergo chest x-ray (CXR) to evaluate for pneumonia. The rate of false-negative CXR in patients with pneumonia is unclear.

OBJECTIVES: Identify patients admitted with pneumonia who were diagnosed by CT despite nondiagnostic CXR.

METHODS: Retrospective analysis of quality improvement data on adult ED patients admitted with pneumonia over 21 months. Primary outcome was percent of patients diagnosed by CT despite normal CXR. Patients were classified as CXR-diagnosed if they had CXR and no CT, or if antibiotics were ordered after CXR and before CT. CT-based diagnosis was indicated by administration of antibiotics only after CT was completed.

RESULTS: 49 patients (11.4%) were diagnosed by CT (p<0.001). These patients were younger (p<0.001) and more often complained of chest pain (p<0.001).

CONCLUSIONS: Patients with pneumonia may present with normal or nondiagnostic CXR, although false negatives may be less common than previously reported.

Original language	English (US)
Pages (from-to)	20-23
Number of pages	4
Journal	Rhode Island medical journal (2013)
Volume	97
Issue number	8
State	Published - Aug 1 2014
Externally published	Yes

Keywords

chest radiograph
computed tomography
false negative
pneumonia

ASJC Scopus subject areas

General Medicine

Cite this

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title = "False-negative chest radiographs in emergency department diagnosis of pneumonia",

abstract = "BACKGROUND: Emergency department (ED) patients frequently undergo chest x-ray (CXR) to evaluate for pneumonia. The rate of false-negative CXR in patients with pneumonia is unclear.OBJECTIVES: Identify patients admitted with pneumonia who were diagnosed by CT despite nondiagnostic CXR.METHODS: Retrospective analysis of quality improvement data on adult ED patients admitted with pneumonia over 21 months. Primary outcome was percent of patients diagnosed by CT despite normal CXR. Patients were classified as CXR-diagnosed if they had CXR and no CT, or if antibiotics were ordered after CXR and before CT. CT-based diagnosis was indicated by administration of antibiotics only after CT was completed.RESULTS: 49 patients (11.4%) were diagnosed by CT (p<0.001). These patients were younger (p<0.001) and more often complained of chest pain (p<0.001).CONCLUSIONS: Patients with pneumonia may present with normal or nondiagnostic CXR, although false negatives may be less common than previously reported.",

keywords = "chest radiograph, computed tomography, false negative, pneumonia",

author = "Maughan, {Brandon C.} and Nicholas Asselin and Carey, {Jennifer L.} and Andrew Sucov and Valente, {Jonathan H.}",

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TY - JOUR

T1 - False-negative chest radiographs in emergency department diagnosis of pneumonia

AU - Maughan, Brandon C.

AU - Asselin, Nicholas

AU - Carey, Jennifer L.

AU - Sucov, Andrew

AU - Valente, Jonathan H.

PY - 2014/8/1

Y1 - 2014/8/1

N2 - BACKGROUND: Emergency department (ED) patients frequently undergo chest x-ray (CXR) to evaluate for pneumonia. The rate of false-negative CXR in patients with pneumonia is unclear.OBJECTIVES: Identify patients admitted with pneumonia who were diagnosed by CT despite nondiagnostic CXR.METHODS: Retrospective analysis of quality improvement data on adult ED patients admitted with pneumonia over 21 months. Primary outcome was percent of patients diagnosed by CT despite normal CXR. Patients were classified as CXR-diagnosed if they had CXR and no CT, or if antibiotics were ordered after CXR and before CT. CT-based diagnosis was indicated by administration of antibiotics only after CT was completed.RESULTS: 49 patients (11.4%) were diagnosed by CT (p<0.001). These patients were younger (p<0.001) and more often complained of chest pain (p<0.001).CONCLUSIONS: Patients with pneumonia may present with normal or nondiagnostic CXR, although false negatives may be less common than previously reported.

AB - BACKGROUND: Emergency department (ED) patients frequently undergo chest x-ray (CXR) to evaluate for pneumonia. The rate of false-negative CXR in patients with pneumonia is unclear.OBJECTIVES: Identify patients admitted with pneumonia who were diagnosed by CT despite nondiagnostic CXR.METHODS: Retrospective analysis of quality improvement data on adult ED patients admitted with pneumonia over 21 months. Primary outcome was percent of patients diagnosed by CT despite normal CXR. Patients were classified as CXR-diagnosed if they had CXR and no CT, or if antibiotics were ordered after CXR and before CT. CT-based diagnosis was indicated by administration of antibiotics only after CT was completed.RESULTS: 49 patients (11.4%) were diagnosed by CT (p<0.001). These patients were younger (p<0.001) and more often complained of chest pain (p<0.001).CONCLUSIONS: Patients with pneumonia may present with normal or nondiagnostic CXR, although false negatives may be less common than previously reported.

KW - chest radiograph

KW - computed tomography

KW - false negative

KW - pneumonia

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JO - Rhode Island medical journal (2013)

JF - Rhode Island medical journal (2013)

IS - 8

ER -

False-negative chest radiographs in emergency department diagnosis of pneumonia

Abstract

Keywords

ASJC Scopus subject areas

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