Yield of Follow-up Chest X-rays for Infection-associated Changes in Same Day Emergency Care

Area of Science:

• Pulmonary Medicine
• Radiology
• Oncology

Background:

• Chest X-rays (CXRs) are frequently used to monitor respiratory infection-related changes and exclude malignancy.
• Same Day Emergency Care (SDEC) units manage urgent ambulatory care patients.
• The diagnostic yield of follow-up CXRs in SDEC populations is not well-established.

Purpose of the Study:

• To evaluate the findings and clinical benefit of follow-up CXRs in patients attending SDEC.
• To assess the detection rate of malignancy and non-malignant conditions from these follow-up CXRs.

Main Methods:

• Retrospective service evaluation of adult SDEC patients between June 2020 and September 2023.
• Identification of CXRs performed as follow-up for infection-related findings.
• Outcomes were stratified based on lung malignancy risk factors.

Main Results:

• Out of 27,336 CXRs, 419 were identified as follow-up studies.
• 341 CXRs assessed infection resolution; 89% showed resolution, 11% persistent changes.
• Two malignancies and several non-malignant conditions (e.g., interstitial lung disease) were found among persistent changes, with both cancer patients over 50 and having risk factors.

Conclusions:

• The low incidence of malignancy detected via follow-up CXRs in SDEC patients suggests a potential benefit from risk-factor-guided imaging.
• Non-malignant findings from these follow-up CXRs can still provide significant clinical value for patient management.