Assessment of Chest X-Ray Utilization for the Evaluation of Non-Traumatic Chest Pain in an Academic Emergency Department

Pericarditis and spontaneous pneumomediastinum are among the pathologies that are in differential diagnoses when a patient describes dorsal irradiated chest pain: if the patient is young, male, and long-limbed, it is necessary to exclude an acute aortic syndrome firstly. We present the case of a young man who arrived at the Emergency Department for chest pain: an echocardiogram performed an immediate diagnosis of pericarditis. However, if the patient had performed a chest X-ray, this would have enabled the observation of pneumomediastinum, allowing a correct diagnosis of pneumomediastinum and treatment. The purpose of this report is to highlight the importance of the diagnostic process.

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Prospective Validation and Refinement of a Decision Rule to Obtain Chest X‐ray in Patients With Nontraumatic Chest Pain in the Emergency Department

Academic Emergency Medicine ◽

10.1111/acem.13386 ◽

2018 ◽

Vol 25 (6) ◽

pp. 650-656

Author(s):

Case Newsom ◽

Rebecca Jeanmonod ◽

Wendy Woolley ◽

Nirali Shah ◽

Shellie Asher ◽

...

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Decision Rule ◽

X Ray ◽

Chest X Ray

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Delayed Upper-Airway Injury after Accidental Alkaline Ingestion

Case Reports in Emergency Medicine ◽

10.1155/2014/503205 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

Matthew F. Ryan ◽

Mindy Fernandez ◽

Karen Laauwe

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Upper Airway ◽

Acute Injury ◽

Upper Endoscopy ◽

Shortness Of Breath ◽

X Ray ◽

Airway Injury ◽

Chest X Ray ◽

Alkaline Cleaning

A 62-year-old man presented to the emergency department one week after accidentally drinking an alkaline cleaning agent stored in unlabeled bottle. The day of the incident the patient presented to an outside hospital where he was admitted for an upper endoscopy of the esophagus which was found to be negative for acute injury. An initial chest X-ray taken the day of the incident was also found to be normal. After discharge the patient continued to have a sore throat and marked dysphagia which caused him to vomit repeatedly. Moreover, the patient began to develop chest pain with associated shortness of breath. We present a case of delayed airway injury and tracheal thickening and associated chest pain after alkaline ingestion and we discuss herein the pathophysiology and management of alkaline ingestions.

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CPD - Chest pain and breathlessness

The Physician ◽

10.38192/1.6.1.10 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Kassiani Iliadou

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Abdominal Discomfort ◽

X Ray ◽

Chest X Ray

Presentation A 74-year-old man presented to the emergency department with chest pain, breathlessness and abdominal discomfort for 2 days. His chest X-ray is given below. Can you identify the main findings in this X-ray?

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Correction to: Chest x-ray severity score in COVID-19 patients on emergency department admission: a two-centre study

European Radiology Experimental ◽

10.1186/s41747-021-00215-3 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Cristian Giuseppe Monaco ◽

Federico Zaottini ◽

Simone Schiaffino ◽

Alessandro Villa ◽

Gianmarco Della Pepa ◽

...

Keyword(s):

Emergency Department ◽

Severity Score ◽

X Ray ◽

Emergency Department Admission ◽

Centre Study ◽

Chest X Ray

An amendment to this paper has been published and can be accessed via the original article.

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Ground-glass opacity on Emergency Department chest X-ray: a risk factor for in-hospital mortality and organ failure in elderly admitted for COVID-19

Postgraduate Medicine ◽

10.1080/00325481.2021.2021741 ◽

2021 ◽

Author(s):

Noel Roig-Marín ◽

Pablo Roig-Rico

Keyword(s):

Emergency Department ◽

Risk Factor ◽

Hospital Mortality ◽

Organ Failure ◽

Ground Glass Opacity ◽

Ground Glass ◽

X Ray ◽

Chest X Ray

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The Hanging Chin Sign As A Mortality Predictor In Geriatric Patients At The Emergency Department: A Retrospective Cohort Study

10.21203/rs.3.rs-496256/v1 ◽

2021 ◽

Author(s):

Anneloes NJ Huijgens ◽

Laurens J van Baardewijk ◽

Carolina JPW Keijsers

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Geriatric Patients ◽

Lateral View ◽

X Ray ◽

Hospital Patients ◽

Chest X Ray

Abstract BACKGROUND: At the emergency department, there is a need for an instrument which is quick and easy to use to identify geriatric patients with the highest risk of mortality. The so- called ‘hanging chin sign’, meaning that the mandibula is seen to project over one or more ribs on the chest X-ray, could be such an instrument. This study aims to investigate whether the hanging chin sign is a predictor of mortality in geriatric patients admitted through the emergency department. METHODS: We performed an observational retrospective cohort study in a Dutch teaching hospital. Patients of ≥ 65 years who were admitted to the geriatric ward following an emergency department visit were included. The primary outcome of this study was mortality. Secondary outcomes included the length of admission, discharge destination and the reliability compared to patient-related variables and the APOP screener.RESULTS: 396 patients were included in the analysis. Mean follow up was 300 days; 207 patients (52%) died during follow up. The hanging chin sign was present in 85 patients (21%). Patients with the hanging chin sign have a significantly higher mortality risk during admission (OR 2.94 (1.61 to 5.39), p < 0.001), within 30 days (OR 2.49 (1.44 to 4.31), p = 0.001), within 90 days (OR 2.16 (1.31 to 3.56), p = 0.002) and within end of follow up (OR 2.87 (1.70 to 4.84),p < 0.001). A chest X-ray without a PA view or lateral view was also associated with mortality. This technical detail of the chest x-ray and the hanging chin sign both showed a stronger association with mortality than patient-related variables or the APOP screener. CONCLUSIONS: The hanging chin sign and other details of the chest x-ray were strong predictors of mortality in geriatric patients presenting at the emergency department. Compared to other known predictors, they seem to do even better in predicting mortality.

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Suggests More Tests for Chest Pain Diagnosis

PEDIATRICS ◽

10.1542/peds.61.1.143b ◽

1978 ◽

Vol 61 (1) ◽

pp. 143-144

Author(s):

Michael F. Elmore ◽

Glen A. Lehman

Keyword(s):

Chest Pain ◽

Physical Examination ◽

Pediatric Patients ◽

Laboratory Studies ◽

Psychiatric Interview ◽

X Ray ◽

Pain Diagnosis ◽

Chest X Ray ◽

Pain Characteristics ◽

Diagnostic Work

Driscoll et al. (Pediatrics 57:648, May 1976) reported a series of 43 patients with chest pain evaluated by history and physical examination, psychiatric interview, screening laboratory studies, ECG, and chest x-ray film. No organic cause was identified in 45% of patients, and various psychiatric aspects of the pain were discussed. The history obtained from pediatric patients is often suboptimal, and specific pain characteristics and associations cannot be defined. We therefore propose that more vigorous diagnostic work-ups are necessary before chest pain can be classed as "idiopathic."

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Chest X-ray Utilization in Febrile Infants 60 Days or Less in the Emergency Department

10.1542/peds.147.3_meetingabstract.275-a ◽

2021 ◽

Author(s):

Erin Bell ◽

Kristen Manto ◽

Giang Ha ◽

Nabeal Aljabban ◽

Lilia Reyes

Keyword(s):

Emergency Department ◽

X Ray ◽

Chest X Ray

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Early clinical predictors of severe acute respiratory syndrome in the emergency department

CJEM ◽

10.1017/s148180350000885x ◽

2004 ◽

Vol 6 (01) ◽

pp. 12-21 ◽

Cited By ~ 2

Author(s):

W.N. Wong ◽

Antonio C.H. Sek ◽

Rick F.L. Lau ◽

K.M. Li ◽

Joe K.S. Leung ◽

...

Keyword(s):

Emergency Department ◽

Severe Acute Respiratory Syndrome ◽

Lymphocyte Count ◽

Case Definition ◽

World Health ◽

Clinical Predictors ◽

X Ray ◽

Abnormal Chest ◽

Contact Exposure ◽

Chest X Ray

ABSTRACT Objectives: To assess the association of diagnostic predictors available in the emergency department (ED) with the outcome diagnosis of severe acute respiratory syndrome (SARS). Methods: This retrospective cohort study describes all patients from the Amoy Garden complex who presented to an ED SARS screening clinic during a 2-month outbreak. Clinical and diagnostic predictors were recorded, along with ED diagnoses. Final diagnoses were established independently based on diagnostic tests performed after the ED visit. Associations of key predictors with the final diagnosis of SARS were described. Results: Of 821 patients, 205 had confirmed SARS, 35 undetermined SARS and 581 non-SARS. Multivariable logistic regression showed that the strongest predictors of SARS were abnormal chest x-ray (odds ratio [OR] = 17.4), subjective fever (OR = 9.7), temperature >38°C (OR = 6.4), myalgias (OR = 5.5), chills and rigors (OR = 4.0) and contact exposure (OR = 2.6). In a subset of 176 patients who had a complete blood cell count performed, the strongest predictors were temperature ≥38ºC (OR = 15.5), lymphocyte count <1000 (OR = 9.3) and abnormal chest x-ray (OR = 5.7). Diarrhea was a powerful negative predictor (OR = 0.03) of SARS. Conclusions: Two components of the World Health Organization case definition — fever and contact exposure — are helpful for ED decision-making, but respiratory symptoms do not discriminate well between SARS and non-SARS. Emergency physicians should consider the presence of diarrhea, chest x-ray findings, the absolute lymphocyte count and the platelet count as significant modifiers of disease likelihood. Prospective validation of these findings in other clinical settings is desirable.

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