Chest X-Ray Not Routinely Indicated Prior to the YEARS Algorithm in the Diagnostic Management of Suspected Pulmonary...

Area of Science:

• Radiology
• Pulmonary Medicine
• Diagnostic Imaging

Background:

• The YEARS algorithm aims to streamline pulmonary embolism (PE) diagnosis and reduce computed tomography pulmonary angiography (CTPA) use.
• Chest X-ray (CXR) is frequently the initial imaging modality for patients with suspected PE.

Purpose of the Study:

• To compare CXR findings in patients with confirmed PE versus those with PE ruled out.
• To evaluate if CXR offers additional diagnostic value to the YEARS criteria for CTPA selection.

Main Methods:

• Post-hoc analysis of 1,473 consecutive patients with suspected PE managed by the YEARS algorithm.
• CXR was performed as part of routine care.
• Prevalence and likelihood ratios of seven key CXR findings for PE diagnosis were calculated.

Main Results:

• Abnormal CXR findings were more common in patients with confirmed PE (36%) compared to those without PE (26%).
• An odds ratio of 1.60 (95% CI: 1.18-2.18) was observed for abnormal CXR in PE patients.
• Only rare findings like fractures or pneumothorax significantly reduced PE probability, potentially avoiding CTPA.

Conclusions:

• Chest X-ray has limited incremental diagnostic value when added to the YEARS algorithm for ruling out PE.
• While CXR is more frequently abnormal in PE cases, it does not reliably rule out the condition.
• Routine CXR prior to CTPA in all suspected PE patients is not recommended based on these findings.