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Diagnostic Value

Stanley Sherman, MD; Joseph A. Skoney, MD; K. P. Ravikrishnan, MD

Arch Intern Med. 1989;149(11):2493-2496.

Abstract
• Routine admission chest radiographs were abnormal in 35 (14%) of 242 patients hospitalized with an exacerbation of chronic obstructive pulmonary disease and resulted in management changes that were appropriate and clinically significant in only 11 cases (4.5%). Based on our analysis of clinical variables predictive of significant radiographic abnormalities and our assessment of clinically important findings, we propose the following indications for admission chest radiographs in patients with an acute exacerbation of chronic obstructive pulmonary disease: white blood cell count above 15x109/L and poly morphonuclear leukocyte count above 8x10⁹/L, history of congestive heart failure, history of coronary artery disease, chest pain, or edema. In view of the low yield of clinically significant abnormalities, we believe that routine chest radiographs need not be performed in this patient population. The use of selective criteria could eliminate unnecessary studies while assuring recognition of important new radiographic abnormalities.

(Arch Intern Med. 1989;149:2493-2496)

Author Affiliations
From the Pulmonary Division, Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Mich.

Footnotes
Accepted for publication June 23, 1989.

Read in part before the Annual Meeting of the American College of Chest Physicians, Anaheim, Calif, October 5,1988.

Reprint requests to Pulmonary Division, Department of Internal Medicine, William Beaumont Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48072 (Dr Sherman).

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