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Stroke code chest radiographs are not useful.

Larry B Goldstein1

  • 1Department of Medicine (Neurology), Duke Center for Cerebrovascular Disease, Center for Clinical Health Policy Research, Duke University, NC, USA. golds004@mc.duke.edu

Cerebrovascular Diseases (Basel, Switzerland)
|September 20, 2007
PubMed
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Routine chest X-rays for acute stroke patients rarely offer benefits. This imaging exposes patients to unnecessary radiation and costs without impacting emergency department care.

Area of Science:

  • Emergency Medicine
  • Radiology
  • Neurology

Background:

  • Chest radiographs are generally not recommended for hospitalized stroke patients without pulmonary symptoms.
  • The study assessed the utility of chest X-rays in hyperacute stroke evaluations by a stroke team.

Purpose of the Study:

  • To evaluate the diagnostic yield and impact of routine chest radiographs in the emergency department (ED) evaluation of acute stroke patients.
  • To determine if chest X-rays influence the management of patients assessed by a stroke code team.

Main Methods:

  • Retrospective analysis of demographic data, chest radiograph results, and ED management for 113 consecutive patients evaluated by a stroke code team (2005-2006).
  • Data collected included the indication for chest radiographs and their findings.

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Main Results:

  • Chest radiographs were performed in 92% of patients, primarily indicated for 'stroke' (91%) or endotracheal intubation.
  • 70% of chest X-rays were normal; 25.2% showed incidental findings, and 3.8% had potentially relevant findings.
  • No chest radiograph findings altered the emergency department management of any patient.

Conclusions:

  • Routine chest radiographs in the emergent evaluation of acute stroke are of limited value.
  • These tests expose patients to radiation, incur costs, and can delay critical assessments.
  • Discontinuation of routine chest X-rays in this setting is suggested to optimize patient care and resource allocation.