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Routine chest X-ray in atraumatic chest pain with normal vital signs: A propensity-matched TriNetX analysis.

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Routine chest x-rays (CXR) for emergency department patients with chest pain and normal vital signs show a statistically significant but clinically negligible increase in pneumonia detection. These findings suggest reducing routine CXR in this low-risk population.

Keywords:
Chest X-rayChest painDiagnostic yieldElectronic health recordsEmergency departmentPneumoniaTriNetX

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Area of Science:

  • Emergency Medicine
  • Diagnostic Imaging
  • Cardiology

Background:

  • Chest pain is a common emergency department presentation requiring rapid risk stratification.
  • The diagnostic utility of chest x-rays (CXR) in these patients is uncertain.
  • This study evaluates the yield of CXR in chest pain patients with normal vital signs.

Purpose of the Study:

  • To determine the prevalence of clinically relevant findings on CXR in chest pain patients.
  • To compare the diagnostic yield of CXR in patients with and without CXR.
  • To assess the clinical significance of CXR findings in low-risk chest pain presentations.

Main Methods:

  • Retrospective analysis of 204,966 patients from the TriNetX network.
  • Included adult ED patients with chest pain and normal vital signs.
  • Propensity score matching balanced cohorts; primary outcome was pneumonia.

Main Results:

  • Pneumonia detection was slightly higher in the CXR group (1.42% vs 0.70%), a statistically significant but negligible difference.
  • Secondary outcomes like cardiomegaly and pleural effusion also showed minimal risk differences.
  • The overall diagnostic yield of CXR in this population was very low.

Conclusions:

  • Routine CXR in chest pain patients with normal vital signs yields minimal clinical benefit.
  • Findings support reducing routine imaging for low-risk chest pain presentations.
  • CXR is most valuable when specific risk factors are present.