Prevalence of negative chest radiography results in the emergency department patient with decompensated heart failure
Prevalence of negative chest radiography results in the emergency department patient with decompensated heart failure
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DOI：
10.1016/j.annemergmed.2005.04.003
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发表时间：
2006-01-01
影响因子：
6.2
通讯作者：
Abraham, WT
中科院分区：
文献类型：
--
作者：
Collins, SP;Lindsell, CJ;Abraham, WT
研究目的：尽管胸部x线摄影快速且价格低廉，但以往的研究表明，在急诊科（ED）失代偿性心力衰竭患者中，胸部x线摄影往往会产生误导，导致误诊和治疗不当。本研究确定了发现有疾病的患者胸片阴性结果的比率，以及阴性结果对急诊医生诊断与心力衰竭不一致的潜在贡献。方法：我们使用了急性失代偿性心力衰竭国家登记处（粘附）的数据，这是一个初级医院出院诊断为心力衰竭的患者登记处。我们比较了首次在急诊科接受治疗的患者的初始ED入院诊断与心力衰竭出院诊断的标准，并将其与心衰（间质性水肿、肺水肿或血管充血，由放射科工作人员确定）的x线表现联系起来。计算了非心力衰竭ED诊断的患者比例和心衰x线表现的诊断敏感性。结果：85,376例患者有胸片结果和ED入院诊断。总体而言，有15,937例患者在ED胸片上没有充血迹象，阴性率为18.7%（95%置信区间[CI] 18.4%至18.9%）。胸片结果阴性的ED非心力衰竭患者入院诊断的比例（23.3%,95% CI 22.6% ~ 23.9%）高于胸片结果阳性的患者（13.0%,95% CI 12.7% ~ 13.2%）。结论：约1 / 5的急诊科急性失代偿性心力衰竭患者胸片无充血征象。在ED胸片上没有充血迹象的患者比有充血迹象的患者更容易被诊断为ED非心力衰竭。临床医生不应排除心衰的患者没有x线片征象充血。
Study objective: Although chest radiography is quick and inexpensive, previous research suggests that it is often misleading in emergency department (ED) patients with decompensated heart failure, resulting in misdiagnosis and inappropriate treatment. This study determines the rate of negative chest radiography results in patients found to have disease and the potential contribution of negative findings to a diagnosis discordant with heart failure by an emergency physician.Methods: We used data from the Acute Decompensated Heart Failure National Registry (ADHERE), a registry of patients with a primary hospital discharge diagnosis of heart failure. We compared initial ED admitting diagnosis to the criterion standard of a hospital discharge diagnosis of heart failure and related these to radiographic findings of heart failure (interstitial edema, pulmonary edema, or vascular congestion, as determined by a staff radiologist) for patients first treated in the ED. The proportion of patients with a non-heart failure ED diagnosis and the diagnostic sensitivity of radiographic findings of heart failure are calculated.Results: There were 85,376 patients with chest radiograph results and an ED admitting diagnosis. Overall, there were 15,937 patients with no signs of congestion on ED chest radiography, giving a negative rate of 18.7% (95% confidence interval [CI] 18.4% to 18.9%). The proportion of patients with an ED non-heart failure admitting diagnosis was higher in patients with a negative chest radiograph result (23.3%; 95% CI 22.6% to 23.9%) than in patients with a positive chest radiograph result (13.0%; 95% CI 12.7% to 13.2%).Conclusion: Approximately 1 of every 5 patients admitted from the ED with acute decompensated heart failure had no signs of congestion on chest radiography. Patients lacking signs of congestion on ED chest radiography were more likely to have an ED non-heart failure diagnosis than patients with signs of congestion. Clinicians should not rule out heart failure in patients with no radiographic signs of congestion.