Chest X-Ray Utility in Syncope Lost in Translation

Again, straight out of the ACEP Daily News briefing: “Patients Presenting To ED With Complaints Of Syncope Should Still Undergo Routine Chest X-Rays, Research Suggests.”

This accurately reports the lead of the linked lay medical press article: “ED Patients With Syncope Should Undergo Chest X-Rays

But, it does not accurately reflect the authors’ discussion or conclusions regarding the utility of chest x-ray in syncope.

This is a retrospective evaluation of patients presenting with syncope and having a chest x-ray between 2003 and 2006 – a secondary analysis of the “Boston Syncope Criteria” study. There were 575 patients included in their analysis, 116 of whom had a defined adverse event within 30 days. Of the patients with positive findings on CXR, 15 of those 18 went on to have an adverse event – and I presume this association led to the perpetuation of this headline.

However, in the greater context: only 18 patients out of 575 had abnormal CXR findings, and even the vast majority of patients with adverse events had normal normal CXR findings. Then, an obvious selection bias should be clear with regard to obtaining CXR in those patients with the appropriate clinical indications – such as a suspicion for CHF or pneumonia. Patients go on to have adverse events because of the morbidity associated with concomitant clinical syndromes, of which the findings on CXR are only one small part of their evaluation.

In short, no, CXR is so low-yield it need not be performed anywhere remotely near routinely in syncope. It may be performed to evaluate a specific presenting symptom related to a syncopal event, but, if anything, these data should indicate it ought be performed less frequently.

“Utility of Chest Radiography in Emergency Department Patients Presenting with Syncope”
http://westjem.com/original-research/utility-of-chest-radiography-in-emergency-department-patients-presenting-with-syncope.html

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