COPD, asthma: uncomplicated cases were unlikely to have a chest X-ray that led to a change in management

Clinical bottom line (level 2b)

  1. One in five patients with an acute exacerbation of asthma or COPD had a chest X-ray that leads to a change in management.
  2. Patients classified as uncomplicated were much less likely to have a chest X-ray that led to a change in management.
Tsai et al: Annals of Emergency Medicine 1993; 22: 1854-1858
Expires November 2003

The study

Setting: emergency department, acute hospital, USA

115 patients (aged 18 to 93; mean 50, 64% female) with an exacerbation of asthma or COPD who failed to respond to frequent use of nebulised beta-agonsts and corticosteroids

Excluded if
  • aged < 18



    • Independent blinded reference standard, applied in all patients from a non-consecutive appropriate spectrum.
    Reference standard:
    • chest X-ray leading to altered management within first 48 hours
    Diagnostic test: complicated cases: any of - COPD, history of fever or temperature > 37.8 C, heart disease, iv drug abuse, seizures, immunosuppressed, other pulmonary disease or thoracic surgery

    The evidence

    pre-test probability of chest X-ray altered management: 21%, (95% CI: 14% to 28%)

    diagnostic test chest X-ray altered management no change in management LR+
    (95% CI)    		 post-test probability LR-
    (95% CI)    		 post-test probability
    complicated case 26 58 1.7
    (1.4 to 2.0)     		31% 0.087
    (0.013 to 0.60)     		2%
    total 27 101

    Comments

    1. 'Altered management' was not defined further.
    2. The false negative case was subsequently read as normal by the staff radiologist.

    Citation

    1. Tsai TW, Gallagher EJ, Lombardi G, et al: guidelines for the selective ordering of admission chest radiography in adult obstructive airway disease. Annals of Emergency Medicine 1993; 22: 1854-1858
    Search Terms:
    Contributor: Bob Phillips and Chris Ball, November 1999
    Reviewer: William Stringer

    Clinical Question.
    Patient obstructive airway exacerbation (asthma or COPD)
    Intervention or Exposure defined as a complicated case
    Outcome chest X-ray leading to a change in management