False-negative chest radiographs in emergency department diagnosis of pneumonia

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

Research output: Contribution to journalArticle

11 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)20-23
Number of pages4
JournalRhode Island medical journal (2013)
Volume97
Issue number8
StatePublished - Aug 1 2014
Externally publishedYes

Fingerprint

Hospital Emergency Service
Pneumonia
Thorax
X-Rays
Anti-Bacterial Agents
Quality Improvement
Chest Pain

Keywords

  • chest radiograph
  • computed tomography
  • false negative
  • pneumonia

ASJC Scopus subject areas

  • Medicine(all)

Cite this

False-negative chest radiographs in emergency department diagnosis of pneumonia. / Maughan, Brandon; Asselin, Nicholas; Carey, Jennifer L.; Sucov, Andrew; Valente, Jonathan H.

In: Rhode Island medical journal (2013), Vol. 97, No. 8, 01.08.2014, p. 20-23.

Research output: Contribution to journalArticle

Maughan, B, Asselin, N, Carey, JL, Sucov, A & Valente, JH 2014, 'False-negative chest radiographs in emergency department diagnosis of pneumonia', Rhode Island medical journal (2013), vol. 97, no. 8, pp. 20-23.
Maughan, Brandon ; Asselin, Nicholas ; Carey, Jennifer L. ; Sucov, Andrew ; Valente, Jonathan H. / False-negative chest radiographs in emergency department diagnosis of pneumonia. In: Rhode Island medical journal (2013). 2014 ; Vol. 97, No. 8. pp. 20-23.
@article{67315c41da2d499d8ba5de2142cffcdd,
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 = "Brandon Maughan and Nicholas Asselin and Carey, {Jennifer L.} and Andrew Sucov and Valente, {Jonathan H.}",
year = "2014",
month = "8",
day = "1",
language = "English (US)",
volume = "97",
pages = "20--23",
journal = "Rhode Island medicine",
issn = "2327-2228",
publisher = "Rhode Island Medical Society",
number = "8",

}

TY - JOUR

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

AU - Maughan, Brandon

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

UR - http://www.scopus.com/inward/record.url?scp=84943358404&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84943358404&partnerID=8YFLogxK

M3 - Article

C2 - 25083953

AN - SCOPUS:84943358404

VL - 97

SP - 20

EP - 23

JO - Rhode Island medicine

JF - Rhode Island medicine

SN - 2327-2228

IS - 8

ER -