Contribution and treatment of adult patients admitted to the emergency department because of nontraumatic chest pain or dyspnea

Plain chest radiography is one of the most common imaging techniques used in the emergency departments (ED). Cost-effective and rational utilization of chest radiography in ED has been a major concern in the literature. The objective of this study is to investigate the contribution of chest X-rays in the diagnosis and treatment of patients with chest pain or dsypnea and to analyze the reliability between the treatment strategies before and after the radiography. This sectional, observational study was conducted in Dokuz Eylül University Hospital ED between July 1st 2000 and September 1st 2000. Three hundred and eighty seven consecutive adult patients admitted to our ED, with the chief complaints of nontraumatic chest pain and/or dsypnea. The relationship of demographic data with the change in treatment plan after x-ray was analyzed with chi-square test and the coherence between the first and last treatment plans was analyzed via kappa statistics. The treatment plans were changed in 50 of 387 subjects after x-rays. The detection of change of plans was not significantly related to age, sex, disease in the history and radiographic technique. The relationship of plan change and complaint at admission, initial diagnosis, first treatment plan and radiological diagnosis, findings in radiographs and treatment were found statistically significant. The reliability between the first and final treatment plans of emergency physcians was found statistically significant. We concluded that a major contribution of plain chest radiographs could be expected in the diagnosis and treatment of ED patients with dyspnea who were suspected to have pneumonia, pneumothroax, chronic obstructive pulmonary disease, lung cancer and congestive heart disease. On the other hand, the yield of the technique will be small in patients whose initial diagnosis were uncomplicated asthma or other lung diseases, nonspecific chest pain and other cardiac problems. Further large-scale randomized and blinded studies are needed for more conclusive data.