The Diagnostic Performance and Utility of Chest XR in Relation to Chest CT in Nontraumatic Respiratory Emergency Patients

Abstract

Background and Aim: This study aimed to determine the diagnostic performance and utility of chest radiography in relation to chest computed tomography (CT) in nontraumatic respiratory emergency patients.

Patients and Methods: Patients presenting to the emergency department with respiratory complaints due to nontraumatic pathologies and who had consecutive chest XR and chest CT assessments with an interval of fewer than 6 hours were enrolled in the study (n = 561).

Results: The two methods were determined to be consistent with moderate agreement in detecting pleural effusion (κ = 0.576, P < 0.001), pneumothorax (κ = 0.567, P < 0.001), increased cardiothoracic ratio (κ =0.472, P < 0.001), and pneumonic consolidation (κ = 0.465, P < 0.001). The consistency rate was significantly higher in patients aged <40 years (95.5% in ≤30 years and 90.9% in 31–40 years) as compared to older patients (81.8%, 68.2%, and 72.7% in 41–60 years, 61–80 years, and >80 years, respectively; P < 0.001 for each). The consistency rate was also higher for posteroanterior (PA) chest XR views than for anteroposterior (AP) chest XR views (72.7% vs. 68.2%, P = 0.005) and for high- and moderate-quality chest XR views than for poor-quality views (72.7% and 77.3% vs. 70.5%, P = 0.001).

Conclusion: The consistency between the chest XR and CT was more likely in patients aged <40 years and for PA and moderate-to-high quality chest XR views, as compared to older patients and AP and poor-quality views, respectively. We suggest that an upright position PA chest X‑ray with high imaging quality may be the first choice, especially in patients aged <40 years admitted to the emergency department with respiratory symptoms.