A Clinical Decision Rule to Reduce Use of X-Rays in Patients with Chest Pain

A clinical decision rule for reducing chest x-rays could decrease costs, emergency department (ED) length of stay, and radiation exposure. Researchers prospectively studied 529 patients older than 24 (mean age, 60; 60% male) who presented to a Canadian ED with chest pain and possible acute coronary syndromes during a 6-month period. Chest x-rays were classified as normal, abnormal but not requiring acute intervention, or abnormal and requiring acute intervention.

Among 11 patients (2.1%) with films classified as abnormal and requiring acute intervention, 1 had a large pleural effusion that needed drainage, 7 had pulmonary edema, and 3 had pneumonia. Among 36 patients (6.8%) with films classified as abnormal but not requiring acute interventi…