Utility of Emergency Department Chest Imaging in Patients with Cancer: A Descriptive Study

J Emerg Med. 2020 Sep;59(3):396-402. doi: 10.1016/j.jemermed.2020.05.007. Epub 2020 Jun 24.

Abstract

Background: The use of computed tomography (CT) has been scrutinized in emergency medicine, particularly in patients with cancer. Previous studies have characterized the rate of CT use in this population; however, limited data are available about the yield of this modality compared with radiography and its clinical decision-making effect.

Objective: To determine whether CT imaging of the chest increases identification of clinically significant results compared with chest radiography (CXR) in patients with cancer.

Methods: This was a retrospective chart review of patients with a history of solid tumors presenting to an emergency department in 2017. Patients who received both CXR and CT (or CT angiography) of the chest during their assessment were identified and the rate of clinically significant findings on imaging was compared. Clinical findings were further categorized as requiring nonurgent, urgent, or emergent attention. Descriptive statistics and chi-squared testing were performed between the 2 imaging modalities.

Results: From 839 patients meeting inclusion criteria, 287 were randomly sampled. The predominant malignancies were lung (32.4%), breast (13.9%), and head and neck cancer (13.6%). A greater number of patients had clinically significant findings identified on CT imaging (n = 222) compared with CXR (n = 108). Stratification upon urgency of these findings (nonurgent, urgent, or emergent) reveals a significant difference in all strata (p < 0.05).

Conclusions: Compared with CXR, CT imaging of the chest identified significantly more clinically relevant findings requiring attention and consequently affecting clinical decision making.

Keywords: acute care; clinical decision making; imaging; oncology.

MeSH terms

  • Emergency Service, Hospital
  • Humans
  • Neoplasms*
  • Radiography, Thoracic*
  • Retrospective Studies
  • Thorax