Five thousand acute care/emergency department chest radiographs: comparison of requisitions with radiographic findings.

Five-thousand portable or posterior-anterior-lateral radiographs of acute care emergency department patients were interpreted. They revealed serious disease in 35% of patients with chest symptoms, in 27% of all patients examined, and in 18% of patients with noncardiorespiratory symptoms. The highest incidence of abnormal radiographs (42%-79%) occurred in patients with symptoms of congestive heart failure, dyspnea, hemoptysis, dysrhythmia, and hypertension. Asthma (14%) and trauma (5%) presented the lowest incidence of significant findings. Radiographs of patients suspected of having pneumonia were abnormal in 25% of cases, and in those patients with either cough or fever alone, the incidences of pneumonia were 13% and 18%. Whereas 24% of patients with dyspnea alone had radiographic findings of congestive heart failure, 52% of those with congestive heart failure diagnosed on clinical grounds had abnormal radiographs. The chest radiograph continues to be a significantly important examination in the diagnosis of disease, the prevention of overtreatment, and the redirection of clinical investigation in the acute care emergency department unit.