Rothrock et al listed criteria for when to order a chest X-ray for a non-trauma patient in the Emergency Department. These can reduce the number of unnecessary chest X-rays.
Patient: age >= 18 years
Frequency of abnormal chest X-rays: 17%
Criteria:
(1) age >= 60 years
(2) temperature >= 38°C
(3) oxygen saturation < 90%
(4) respiratory rate > 24 breaths per minute
(5) hemoptysis
(6) rales
(7) diminished breath sounds
(8) history of alcohol abuse
(9) tuberculosis
(10) thromboembolic disease
A chest X-ray is ordered if any of the criteria are present.
One modification might be to add immunosuppression or immunodeficiency as an additional criterion.
Performance:
• The sensitivity is 95% and specificity 40%.
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