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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. CDC/National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey: 2013 Emergency Department Summary Tables.  Available at: https://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2013_ed_web_tables.pdf. Review/Other-Dx N/A To summarize the 2013 National Hospital Ambulatory Medical Care Survey. No results stated in abstract. 4
2. Curtin SC, Tejada-Vera B, Bastian BA. Deaths: Leading Causes for 2020. Natl Vital Stat Rep 2023;72:1-115. Review/Other-Dx N/A To present final 2020 data on the 10 leading causes of death in the United States by age, race and Hispanic origin, and sex. No results stated in the abstract. 4
3. Bang TJ, Chung JH, Walker CM, et al. ACR Appropriateness Criteria® Routine Chest Imaging. J Am Coll Radiol 2023;20:S224-S33. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for routine chest imaging. No results stated in abstract. 4
4. Kirsch J, Wu CC, Bolen MA, et al. ACR Appropriateness Criteria® Suspected Pulmonary Embolism: 2022 Update. J Am Coll Radiol 2022;19:S488-S501. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected pulmonary embolism. No results stated in abstract. 4
5. Litmanovich D, Hurwitz Koweek LM, Ghoshhajra BB, et al. ACR Appropriateness Criteria® Chronic Chest Pain-High Probability of Coronary Artery Disease: 2021 Update. J Am Coll Radiol 2022;19:S1-S18. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for chronic chest pain-high probability of coronary artery disease. No results stated in abstract. 4
6. Bolen MA, Bin Saeedan MN, Rajiah P, et al. ACR Appropriateness Criteria® Dyspnea-Suspected Cardiac Origin (Ischemia Already Excluded): 2021 Update. J Am Coll Radiol 2022;19:S37-S52. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for dyspnea-suspected cardiac origin (ischemia already excluded). No results stated in abstract. 4
7. McComb BL, Ravenel JG, Steiner RM, et al. ACR Appropriateness Criteria® Chronic Dyspnea-Noncardiovascular Origin. J Am Coll Radiol 2018;15:S291-S301. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for chronic dyspnea-noncardiovascular origin. No results stated in abstract. 4
8. Lee C, Colletti PM, Chung JH, et al. ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompromised Patients. J Am Coll Radiol 2019;16:S331-S39. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for acute respiratory illness in immunocompromised patients, No results stated in abstract. 4
9. Sperandeo M, Carnevale V, Muscarella S, et al. Clinical application of transthoracic ultrasonography in inpatients with pneumonia. Eur J Clin Invest. 41(1):1-7, 2011 Jan. Observational-Dx 391 patients To investigate the clinical applicability of transthoracic ultrasound (TUS) in the diagnosis and follow-up of community acquired pneumonia (CAP). Concerning the reproducibility of TUS method, no reader's bias was present (P=0.18), overall variability and between-subject variability (inter-reader agreement) did not show any difference between readers (P = 0.62 and P = 0.32 respectively), and estimated within-subject variabilities (intra-reader agreement) suggested a very high repeatability of the method (P approximately 1). Of 342 patients with Rx diagnosis of CAP, in 314 patients (92% of cases) a pulmonary consolidation was also detected using TUS, whose ultrasonographic patterns were studied. Pleural effusion was detected in 120/342 (35%) patients using ultrasound and in 111/342 (32%) patients using chest radiography. Overall dimensional changes of the lung consolidated areas assessed with TUS method showed highly significant results. (1st day mean +/- SD: 66.34 +/- 19.25; 4th day: 39.92 +/- 14.61; 8-10th day: 7.41 +/- 1.50; P < 0.0001). 2
10. Ebrahimzadeh A, Mohammadifard M, Naseh G, Mirgholami A. Clinical and Laboratory Findings in Patients With Acute Respiratory Symptoms That Suggest the Necessity of Chest X-ray for Community-Acquired Pneumonia. Iran J Radiol. 2015;12(1):e13547. Observational-Dx 420 patients. To derive practical criteria for performing chest radiographs for the evaluation of community-acquired pneumonia (CAP). The data showed that vital signs and physical examination findings are useful screening parameters for predicting chest radiograph findings in outpatient settings. Therefore, by implementing a prediction rule, we would be able to determine which patients would benefit from a chest X-Ray (sensitivity, 94% and specificity, 57%). 2
11. O'Brien WT Sr, Rohweder DA, Lattin GE Jr, et al. Clinical indicators of radiographic findings in patients with suspected community-acquired pneumonia: who needs a chest x-ray?. Journal of the American College of Radiology. 3(9):703-6, 2006 Sep. Observational-Dx 350 patients To develop a prediction rule for the use of CXRs in evaluating for CAP based on presenting signs and symptoms. The data show that vital sign and physical examination findings are useful screening parameters for CAP, demonstrating a sensitivity of 95%, a specificity of 56%, and an OR of 24.9 [corrected] in the presence of vital sign or physical examination abnormalities. In light of these results, the authors developed a prediction rule for low-risk patients with reliable follow-up, which states that CXRs are unnecessary in the presence of normal vital signs and physical examination findings. 2
12. Akl EA, Blazic I, Yaacoub S, et al. Use of Chest Imaging in the Diagnosis and Management of COVID-19: A WHO Rapid Advice Guide. Radiology. 298(2):E63-E69, 2021 02. Review/Other-Dx 28 studies To develop a rapid guide on the use of chest imaging in the diagnosis and management of coronavirus disease 2019 (COVID-19). No results stated in the abstract 4
13. Benacerraf BR, McLoud TC, Rhea JT, Tritschler V, Libby P. An assessment of the contribution of chest radiography in outpatients with acute chest complaints: a prospective study. Radiology. 1981; 138(2):293-299. Review/Other-Dx 1,102 consecutive patients To assess the value of CXR in patients with chest complaints to identify selective indications for CXR in this population with relation to the patient's age, the symptoms, and the results of physical examination. Although in patients over 40 years old, chest symptoms are a sufficient indication for CXR, 96% of the patients below age 40 had a normal physical examination of the chest, no hemoptysis, and no acute radiographic abnormalities. If CXRs in the below-40 group had been limited to patients with abnormal physical examinations and/or hemoptysis, 58% of the patients in that group would have been spared the examination. Under these conditions, 2.3% of the acute radiographic abnormalities in the entire population of patients under 40 would have gone undetected. 4
14. Heckerling PS. The need for chest roentgenograms in adults with acute respiratory illness. Clinical predictors. Arch Intern Med. 1986; 146(7):1321-1324. Observational-Dx 464 patients To study the predictive values of several clinical variables for the presence or absence of pneumonia in adults with acute respiratory complaints. Of 464 patients who received a CXR, 129 (27.8%) had pneumonia. None of the symptoms, signs, or laboratory findings evaluated could reliably predict the presence of pneumonia. The absence of abnormal auscultatory findings on lung examination, however, excluded pneumonia with >95% certainty. Among the 106 patients who presented with acute asthma, only 2 (1.9%) had pneumonia. Among the 33 patients with underlying organic brain syndrome, 25 (75.8%) had pneumonia. Incorporating these findings into a diagnostic strategy for ordering CXRs could have reduced the number obtained by 54% and spared 72% of patients without pneumonia unnecessary radiation exposure. 3
15. Okimoto N, Yamato K, Kurihara T, et al. Clinical predictors for the detection of community-acquired pneumonia in adults as a guide to ordering chest radiographs. Respirology. 2006; 11(3):322-324. Observational-Dx 79 outpatients To identify sensitive clinical predictors for the detection of community-acquired pneumonia in adults as a guide to when to order a CXR. A total of 24 patients (30.4%) had radiological evidence of pneumonia. In total, 22 presented with 4 clinical signs: fever, cough, sputum and coarse crackles. The sensitivity and the specificity of detecting pneumonia based on these 4 clinical signs mentioned was 91.7% and 92.7%, respectively. 4
16. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007; 44 Suppl 2:S27-72. Review/Other-Dx N/A Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. No abstract available. 4
17. Broder J. Chapter 5. Imaging the Chest. In: Broder J, ed. Diagnostic Imaging for the Emergency Physician. Saint Louis: W.B. Saunders; 2011:185-296. Review/Other-Dx N/A To discuss Diagnostic the Imaging for the Emergency Physician. No results stated in the abstract. 4
18. Moffett BK, Panchabhai TS, Nakamatsu R, et al. Comparing posteroanterior with lateral and anteroposterior chest radiography in the initial detection of parapneumonic effusions. Am J Emerg Med. 34(12):2402-2407, 2016 Dec. Observational-Dx N/A To identify which technique is preferred for detection of PPEs using chest computed tomography (CCT) as a reference standard. There was a statistically significant difference between the sensitivity of AP (67.3%) and PA/Lat (83.9%) chest radiography for the initial detection of CR-PPE. Of 16 CR-PPEs initially missed by AP radiography, 7 either required drainage initially or developed empyema within 30 days, whereas no complicated PPE or empyema was found in those missed by PA/Lat radiography. 2
19. Bourcier JE, Paquet J, Seinger M, et al. Performance comparison of lung ultrasound and chest x-ray for the diagnosis of pneumonia in the ED. American Journal of Emergency Medicine. 32(2):115-8, 2014 Feb. Observational-Dx 144 patients To assess the potential of bedside lung ultrasound examination by the attending emergency physician in the diagnosis of acute pneumonia. We found a sensitivity of 0.95 for the ultrasound examination against 0.6 for radiography (P < .05). The negative predictive value was 0.67 against 0.25 for radiography (P < .05). 3
20. Cortellaro F, Colombo S, Coen D, Duca PG. Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emergency Medicine Journal. 29(1):19-23, 2012 Jan. Observational-Dx 120 patients To evaluate the diagnostic accuracy of bedside lung ultrasound and chest radiography (CXR) in patients with suspected pneumonia compared with computed tomography (CT) scan and final diagnosis at discharge. 120 patients entered the study. A discharge diagnosis of pneumonia was confirmed in 81 (67.5%). The first CXR was positive in 54/81 patients (sensitivity 67%; 95% CI 56.4% to 76.9%) and negative in 33/39 (specificity 85%; 95% CI 73.3% to 95.9%), whereas lung ultrasound was positive in 80/81 (sensitivity 98%; 95% CI 93.3% to 99.9%) and negative in 37/39 (specificity 95%; 95% CI 82.7% to 99.4%). A CT scan was performed in 30 patients (26 of which were positive for pneumonia); in this subgroup the first CXR was diagnostic for pneumonia in 18/26 cases (sensitivity 69%), whereas ultrasound was positive in 25/26 (sensitivity 96%). The feasibility of ultrasound was 100% and the examination was always performed in less than 5 min. 2
21. Nazerian P, Volpicelli G, Vanni S, et al. Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography. American Journal of Emergency Medicine. 33(5):620-5, 2015 May. Observational-Dx 285 patients To assess the accuracy of  lung ultrasound (LUS) for the diagnosis of lung consolidations when compared to chest computed tomography (CT). We analyzed 285 patients. CT was positive for at least one consolidation in 87 patients. LUS was feasible in all patients and in 81 showed at least one consolidation, with a good inter-observer agreement (k = 0.83), sensitivity 82.8% (95% CI 73.2%-90%) and specificity 95.5% (95% CI 91.5%-97.9%). Sensitivity raised to 91.7% (95% CI 61.5%-98.6%) and specificity to 97.4% (95% CI 86.5%-99.6%) in patients complaining of pleuritic chest pain. In a subgroup of 190 patients who underwent also chest radiography (CXR), the sensitivity of LUS (81.4%, 95% CI 70.7%-89.7%) was significantly superior to CXR (64.3%, 95% CI 51.9%-75.4%) (P<.05), whereas specificity remained similar (94.2%, 95% CI 88.4%-97.6% vs. 90%, 95% CI 83.2%-94.7%). 2
22. Reissig A, Copetti R, Mathis G, et al. Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia: a prospective, multicenter, diagnostic accuracy study. Chest. 142(4):965-972, 2012 Oct. Observational-Dx 229 patients To define the accuracy of lung ultrasound (LUS) in the diagnosis of community-acquired pneumonia (CAP). CAP was confirmed in 229 patients (63.3%). LUS revealed a sensitivity of 93.4% (95% CI, 89.2%-96.3%), specificity of 97.7% (95% CI, 93.4%-99.6%), and likelihood ratios (LRs) of 40.5 (95% CI, 13.2-123.9) for positive and 0.07 (95% CI, 0.04-0.11) for negative results. A combination of auscultation and LUS increased the positive LR to 42.9 (95% CI, 10.8-170.0) and decreased the negative LR to 0.04 (95% CI, 0.02-0.09). We found 97.6% (205 of 211) of patients with CAP showed breath-dependent motion of infiltrates, 86.7% (183 of 211) an air bronchogram, 76.5% (156 of 204) blurred margins, and 54.4% (105 of 193) a basal pleural effusion. During follow-up, median C-reactive protein levels decreased from 137 mg/dL to 6.3 mg/dL at days 13 to 16 as did signs of CAP; median area of lesions decreased from 15.3 cm2 to 0.2 cm2 and pleural effusion from 50 mL to 0 mL. 3
23. Wipf JE, Lipsky BA, Hirschmann JV, et al. Diagnosing pneumonia by physical examination: relevant or relic? Archives of internal medicine 1999;159:1082-7. Observational-Dx 52 patients To determine the accuracy of various physical examination maneuvers in diagnosing pneumonia and to compare the interobserver reliability of the maneuvers among 3 examiners. Twenty-four patients had pneumonia confirmed by chest x-ray films. Twenty-eight patients did not have pneumonia. Abnormal lung sounds were common in both groups; the most frequently detected were rales in the upright seated position and bronchial breath sounds. Relatively high agreement among examiners (kappa approximately 0.5) occurred for rales in the lateral decubitus position and for wheezes. The 3 examiners' clinical diagnosis of pneumonia had a sensitivity of 47% to 69% and specificity of 58% to 75%. 2
24. Meltzer MI. Increased hospitalizations of elderly patients. Emerg Infect Dis. 2008;14(5):847-848. Review/Other-Dx N/A To report that there is increase in Emerging Infectious Diseases among those >65 years of age. No results stated in abstract. 4
25. Trotter CL, Stuart JM, George R, Miller E. Increasing hospital admissions for pneumonia, England. Emerg Infect Dis. 2008;14(5):727-733. Review/Other-Dx N/A To describe trends in pneumonia hospitalizations, we extracted information on all episodes of pneumonia that occurred from April 1997 through March 2005 recorded in the Hospital Episode Statistics (HES) database by searching for International Classification of Diseases 10th revision codes J12-J18 in any diagnostic field. The age-standardized incidence of hospitalization with a primary diagnosis of pneumonia increased by 34% from 1.48 to 1.98 per 1,000 population between 1997-98 and 2004-05. The increase was more marked in older adults, in whom the mortality rate was also highest. The proportion of patients with recorded coexisting conditions (defined by using the Charlson Comorbidity Index score) increased over the study period. The rise in pneumonia hospital admissions was not fully explained by demographic change or increasing coexisting conditions. 4
26. Metlay JP, Schulz R, Li YH, et al. Influence of age on symptoms at presentation in patients with community-acquired pneumonia. Arch Intern Med. 1997;157(13):1453-1459. Review/Other-Dx 1812 patients To evaluate the association between age and the presenting symptoms in patients with community-acquired pneumonia. The 1812 eligible study patients were categorized into 4 age groups: 18 through 44 years (43%), 45 through 64 years (25%), 65 through 74 years (17%), and 75 years or older (15%). For 17 of the 18 symptoms, there were significant decreases in reported prevalence with increasing age (P < .01). In a linear regression analysis, controlling for patient demographics, comorbidity, and severity of illness at presentation, older age remained associated with lower symptom scores (P < .001). 4
27. Aagaard E, Maselli J, Gonzales R. Physician practice patterns: chest x-ray ordering for the evaluation of acute cough illness in adults. Med Decis Making. 2006; 26(6):599-605. Review/Other-Dx 300 adults To examine which clinical factors contribute to the clinician suspicion of pneumonia, as well as the relationship between clinical factors, clinician suspicion of pneumonia, and ordering CXR. Clinician suspicion of pneumonia was low in the majority of patients presenting for evaluation of cough (63%). Higher clinician suspicion of pneumonia was predicted by advanced patient age (OR: 4.6; 95% CI, [1.2-18.1]), shortness of breath (2.4; [1.0-6.0]), fever (5.5; [1.8-17.5]), tachycardia (3.8; [1.1-13.1]), rales (23.8; [5.7-98.7]), and rhonchi (14.6; [5.2-40.5]). CXRs were ordered in 19% of patients presenting with acute cough. Intermediate clinician suspicion of pneumonia (OR: 7.9; 95% CI, [2.8, 22.5]) (vs low suspicion), advanced patient age (=65 years) (9.2; [2.7, 31.6]) (vs ages 18-44 years), and decreased breath sounds on examination (5.1; [1.8, 14.3]) are independent predictors of ordering a CXR. Among patients with a clinical diagnosis of pneumonia (n=31), CXRs were ordered in only 61%. 4
28. Basi SK, Marrie TJ, Huang JQ, Majumdar SR. Patients admitted to hospital with suspected pneumonia and normal chest radiographs: epidemiology, microbiology, and outcomes. Am J Med. 2004; 117(5):305-311. Review/Other-Dx 2,706 adults To describe the prevalence of patients admitted to hospital with a diagnosis of community-acquired pneumonia who have normal CXRs; the extent to which patients actually had pneumonia on radiographs; and to compare presentation and outcomes in patients with a lower respiratory tract infection and those whose clinical diagnosis of pneumonia was confirmed by radiography. One third (n=911) of patients admitted with pneumonia had their initial radiograph reported as “no pneumonia.” Independent review found that only 7% (6/92) of radiographs developed an opacity that confirmed pneumonia. Characteristics were similar among admitted patients irrespective of radiographic findings, although patients without pneumonia on radiograph were older (mean [+/- SD] age, 73 +/- 15 years vs 68 +/- 19 years, P<0.001) and had greater pneumonia-specific severity-of-illness scores (104 +/- 32 vs 99 +/- 37, P=0.004). Patients without radiographic confirmation of pneumonia had similar rates of positive sputum cultures (32% [87/271] vs 30% [208/706], P=0.42) and blood cultures (6% [35/576] vs 8% [100/1241], P=0.13), but microbiology results differed, with a shift away from Streptococcus pneumoniae towards other streptococci species and gram-negative aerobic bacilli. In-hospital mortality was similar for both groups of patients (8% [64/911] in the unconfirmed pneumonia group vs 10% [165/1795] in the confirmed group, adjusted P=0.09). 4
29. Speets AM, Hoes AW, van der Graaf Y, Kalmijn S, Sachs AP, Mali WP. Chest radiography and pneumonia in primary care: diagnostic yield and consequences for patient management. Eur Respir J. 2006; 28(5):933-938. Observational-Dx 192 patients To assess the diagnostic yield of CXR in primary-care patients suspected of pneumonia. Pneumonia was diagnosed by general practitioners in 35 (18%) patients, of whom 27 (14%) patients had a positive CXR, and 8 (4%) patients a negative CXR, but with an assumed high probability of pneumonia by the general practitioner. CXR clearly influenced the diagnosis of pneumonia by the general practitioner in 53% of the patients. CXR ruled out pneumonia in 47% and the probability of pneumonia substantially increased in 6% of the patients. Patient management changed after CXR in 69% of the patients, mainly caused by a reduction in medication prescription (from 43% to 17%) and more frequent reassurance of the patient (from 8% to 35%). 3
30. Roshkovan L, Chatterjee N, Galperin-Aizenberg M, et al. The Role of Imaging in the Management of Suspected or Known COVID-19 Pneumonia. A Multidisciplinary Perspective. [Review]. Annals of the American Thoracic Society. 17(11):1358-1365, 2020 11. Review/Other-Dx N/A To describe radiologic findings that are considered typical, atypical, and generally not compatible with COVID-19. Furthermore, we review imaging examples of COVID-19 imaging mimics, such as organizing pneumonia, eosinophilic pneumonia, and other viral infections. No results stated in the abstract 4
31. Tana C, Ricci F, Coppola MG, et al. Prognostic Significance of Chest Imaging by LUS and CT in COVID-19 Inpatients: The ECOVID Multicenter Study. Respiration. 101(2):122-131, 2022. Observational-Dx 19 in patients To evaluate the prognostic yield of Point-of-care lung ultrasound (LUS) and of High-resolution computed tomography (HRCT) in COVID-19 patients. One hundred fifty-three COVID-19 inpatients (mean age 65 ± 15 years; 65% M), including 23 (15%) in-hospital deaths for any cause over a mean follow-up of 14 days were included. Mean LUS and CT scores were 19 ± 12 and 10 ± 7, respectively. A strong positive linear correlation between LUS and CT scores (Pearson correlation r = 0.754; R2 = 0.568; p < 0.001) was observed. By ROC curve analysis, the optimal cut-point for mortality prediction was 20 for LUS score and 4.5 for chest CT score. According to Kaplan-Meier survival analysis, in-hospital mortality significantly increased among COVID-19 patients presenting with an LUS score =20 (log-rank 0.003; HR 9.87, 95% CI: 2.22-43.83) or a chest CT score =4.5 (HR 4.34, 95% CI: 0.97-19.41). At multivariate Cox regression analysis, LUS score was the sole independent predictor of in-hospital mortality yielding an adjusted HR of 7.42 (95% CI: 1.59-34.5). 2
32. Hayden GE, Wrenn KW. Chest radiograph vs. computed tomography scan in the evaluation for pneumonia. J Emerg Med. 2009; 36(3):266-270. Review/Other-Dx 26 patients had either negative CXR or nondiagnostic To determine, in an emergency department population, the incidence of pneumonia diagnosed on thoracic CT in the setting of negative or nondiagnostic CXRs. Of the 1,057 patients diagnosed with pneumonia, both CXR and CT were performed in 97 cases. Of this group, there were 26 patients (27%), in whom the CXR was either negative or nondiagnostic, but the CT noted an infiltrate/consolidation consistent with pneumonia. The authors find that in 27% of cases in which both a CXR and a CT scan were performed in the workup of varied chief complaints, pneumonia was demonstrated on CT in the face of a negative or nondiagnostic CXR. 4
33. Walker JS, Levy G. Kinetics of drug action in disease states. XXXIV. Effect of experimental thyroid disorders on the pharmacodynamics of phenobarbital, ethanol and pentylenetetrazol. J Pharmacol Exp Ther. 1989;249(1):6-10. Experimental-Tx 68 rats To determine the effect of thyroid disorders on the concentration-activity relationship of certain drugs acting on the central nervous system. The hypnotic dose of ethanol was increased significantly in hyperthyroid rats and decreased in hypothyroid animals; ethanol concentrations in serum, brain and CSF at onset of effect were generally not affected by thyroid dysfunction except for a small but statistically significant increase of serum ethanol concentrations in the hyperthyroid rats. The convulsant dose of pentylenetetrazol was reduced significantly in hypothyroid animals and unaltered in hyperthyroid rats; the concentrations of the convulsant in serum, brain and CSF were not apparently changed by the thyroid dysfunctions. 1
34. Self WH, Courtney DM, McNaughton CD, Wunderink RG, Kline JA. High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients: implications for diagnosing pneumonia. Am J Emerg Med. 2013;31(2):401-405. Observational-Dx 3423 patients To evaluate the diagnostic performance of chest x-ray (CXR) compared to computed tomography (CT) for detection of pulmonary opacities in adult emergency department (ED) patients. The study cohort included 3423 patients. Shortness of breath, chest pain and cough were the most common complaints, with 96.1% of subjects reporting at least one of these symptoms. Pulmonary opacities were visualized on 309 (9.0%) CXRs and 191 (5.6 %) CT scans. CXR test characteristics for detection of pulmonary opacities included: sensitivity 43.5% (95% CI, 36.4%-50.8%); specificity 93.0% (95% CI, 92.1%-93.9%); positive predictive value 26.9% (95% CI, 22.1%-32.2%); and negative predictive value 96.5% (95% CI, 95.8%-97.1%). 3
35. Haga T, Fukuoka M, Morita M, Cho K, Tatsumi K. Computed Tomography for the Diagnosis and Evaluation of the Severity of Community-acquired Pneumonia in the Elderly. Internal Medicine. 55(5):437-41, 2016. Observational-Dx 142 patients To assess the utility of computed tomography (CT) for the diagnosis and ascertainment of the severity of community-acquired pneumonia (CAP) in the elderly. One hundred and forty-two patients, 65 years of age or older, were surveyed upon hospital admission for suspected CAP. Of the 142 patients included, 127 (89.4%) had pneumonic infiltration diagnosed by CT, however, chest radiography (CR) could not recognize pneumonic infiltration in 9.4% (12/127) of these patients. In 127 CAP-positive patients, bilateral pneumonic infiltration was more frequently detected by CT in non-survivors than survivors (79.0% vs. 53.7%; p <0.05). By a multivariable analysis to determine the prognostic factors related to mortality from CAP, oxygen desaturation showed the greatest odds ratio among the other predictive factors, followed by comorbid neoplastic disease, blood urea nitrogen >/=21 mg/dL, male gender, and bilateral pneumonic infiltration diagnosed by CT. 2
36. Schulze M, Vogel W, Spira D, Sauter A, Hetzel J, Horger M. Reduced perfusion in pulmonary infiltrates of high-risk hematologic patients is a possible discriminator of pulmonary angioinvasive mycosis: a pilot volume perfusion computed tomography (VPCT) study. Acad Radiol. 19(7):842-50, 2012 Jul. Observational-Dx 17 patients To assess perfusion parameters in atypical pneumonia of heavily immunocompromised hematologic patients suspected of having invasive mycosis using volume perfusion computed tomography and establish their diagnostic role. Patients with proven, probable, or possible angioinvasive pulmonary fungal infection revealed very low levels of perfusion of their parenchymal consolidations, with BFs ranging from 0.01 to 23.86 mL/100 mL tissue/min and BVs ranging from 0.88 to 10.67 mL/100 mL tissue, lower than those of the adjacent thoracic musculature and of bacterial pneumonias. Bacterial pneumonias showed all increased perfusion parameters, with BFs ranging from 30.49 to 41.65 mL/100 mL tissue/min and BVs ranging from 10.07 to 49.90 mL/100 mL tissue. The cutoff BF value for differentiation was 23.89 mL/100 mL tissue/min, and the cutoff BV value was 9.6 mL/100 mL tissue. 2
37. Maughan BC, Asselin N, Carey JL, Sucov A, Valente JH. False-negative chest radiographs in emergency department diagnosis of pneumonia. R I Med J (2013). 2014;97(8):20-23. Observational-Dx 428 patients. To identify patients admitted with pneumonia who were diagnosed by computed tomography (CT) despite nondiagnostic chest x-ray (CXR). 49 patients (11.4%) were diagnosed by CT (p<0.001). These patients were younger (p<0.001) and more often complained of chest pain (p<0.001). 3
38. Liapikou A, Cilloniz C, Gabarrus A, et al. Multilobar bilateral and unilateral chest radiograph involvement: implications for prognosis in hospitalised community-acquired pneumonia. Eur Respir J 2016;48:257-61. Review/Other-Dx N/A To discuss multilobar bilateral and unilateral chest radiograph involvement: implications for prognosis in hospitalised community. No results stated in the abstract. 4
39. Mirza-Aghazadeh-Attari M, Zarrintan A, Nezami N, et al. Predictors of coronavirus disease 19 (COVID-19) pneumonitis outcome based on computed tomography (CT) imaging obtained prior to hospitalization: a retrospective study. Emergency Radiology. 27(6):653-661, 2020 Dec. Observational-Dx 50 patients To assess the diagnostic and prognostic value of computed tomography (CT) imaging in COVID-19 patients. The common radiologic findings were ground-glass opacities (82%) and airspace consolidation (42%), respectively. Air bronchogram was more commonly seen in deceased patients (p = 0.04). Bilateral and multilobar involvement was more frequently found in deceased patients (p = 0.049 and 0.014, respectively). The mean number of involved lobes was 3.46 ± 1.80 lobes in surviving patients and 4.57 ± 0.60 lobes in the deceased patients (p = 0.009). The difference was statistically significant. The area under the curve for a lung score cutoff of 12 was 0.790. 2
40. Claessens YE, Debray MP, Tubach F, et al. Early Chest Computed Tomography Scan to Assist Diagnosis and Guide Treatment Decision for Suspected Community-acquired Pneumonia. American Journal of Respiratory & Critical Care Medicine. 192(8):974-82, 2015 Oct 15. Observational-Dx 333 patients. To assess whether early multidetector chest computed tomography (CT) scan affects diagnosis and management of patients visiting the emergency department with suspected community-acquired pneumonia (CAP). Chest radiograph revealed a parenchymal infiltrate in 188 patients. CAP was initially classified as definite in 143 patients (44.8%), probable or possible in 172 (53.8%), and excluded in 4 (1.2%). CT scan revealed a parenchymal infiltrate in 40 (33%) of the patients without infiltrate on chest radiograph and excluded CAP in 56 (29.8%) of the 188 with parenchymal infiltrate on radiograph. CT scan modified classification in 187 (58.6%; 95% confidence interval, 53.2-64.0), leading to 50.8% definite CAP and 28.8% excluded CAP, and 80% of modifications were in accordance with adjudication committee classification. Because of CT scan, antibiotics were initiated in 51 (16%) and discontinued in 29 (9%), and hospitalization was decided in 22 and discharge in 23. 3
41. Sodhi KS, Ciet P, Vasanawala S, Biederer J. Practical protocol for lung magnetic resonance imaging and common clinical indications. Pediatr Radiol 2022;52:295-311. Review/Other-Dx N/A To provide the reader with practical easy-to-use protocols for common clinical indications in children. No results stated in th eabstract 4
42. Ekinci A, Yucel Ucarkus T, Okur A, Ozturk M, Dogan S. MRI of pneumonia in immunocompromised patients: comparison with CT. Diagn Interv Radiol. 23(1):22-28, 2017 Jan-Feb. Experimental-Dx 40 patients To investigate the utility of magnetic resonance imaging (MRI) in the diagnosis and surveillance of immunocompromised patients with pneumonia. Infection was determined in 36 patients (90%), while the causative organism remained unknown in four patients (10%). In all the patients, the CT findings were consistent with infection, although three patients showed no abnormal findings on MRI. CT was superior to MRI in the detection of the tree-in-bud nodules, centrilobular nodules, and halo sign (P < 0.001, for all). A significant difference was observed between the MRI sequences and CT in terms of the number of detected nodules (P < 0.001). The nodule detection rate of MRI significantly increased in proportion to the size of the nodule (P < 0.001). All MRI sequences had almost perfect agreement with CT for the detection of consolidation (small ka, Cyrillic=0.950, P < 0.001), patchy increased density (small ka, Cyrillic=1, P < 0.001), pleural effusion (small ka, Cyrillic=0.870, P < 0.001), pericardial effusion (small ka, Cyrillic=1, P < 0.001), reverse halo sign, (small ka, Cyrillic=1 P < 0.001), 10-20 mm, nodules (small ka, Cyrillic=0.896, P < 0.001 for CT and B-FFE; small ka, Cyrillic=0.948, P < 0.001 for CT and T1- or T2-weighted imaging) 10-20 mm, >20 mm nodules (small ka, Cyrillic=0.844, P < 0.001). 2
43. Syrjala H, Broas M, Ohtonen P, Jartti A, Paakko E. Chest magnetic resonance imaging for pneumonia diagnosis in outpatients with lower respiratory tract infection. Eur Respir J. 2017;49(1). Experimental-Dx 77 patients To assess whether magnetic resonance imaging (MRI) is applicable for diagnosing pneumonia among adult outpatients with lower respiratory tract infection. MRI missed two HRCT-identified pneumonia cases due to motion artefacts. Chest radiography resulted in four false-positive pneumonia findings and MRI resulted in none. When HRCT was used as a reference, MRI had a sensitivity of 0.938 (95% CI 0.799-0.983) and specificity of 0.978 (95% CI 0.884-0.996) for the diagnosis of pneumonia, whereas the sensitivity and specificity for chest radiography were 0.719 (95% CI 0.546-0.844) and 0.911 (95% CI 0.793-0.965), respectively. 1
44. Attenberger UI, Morelli JN, Henzler T, et al. 3 Tesla proton MRI for the diagnosis of pneumonia/lung infiltrates in neutropenic patients with acute myeloid leukemia: initial results in comparison to HRCT. Eur J Radiol. 83(1):e61-6, 2014 Jan. Experimental-Dx 19 patients To evaluate the diagnostic accuracy of 3 Tesla proton MRI for the assessment of pneumonia/lung infiltrates in neutropenic patients with acute myeloid leukemia. Pulmonary abnormalities were characterized by 3 Tesla MRI with a sensitivity of 82.3% and a specificity of 78.6%, resulting in an overall accuracy of 88% (NPV/PPV 66.7%/89.5%). In 51 lobes (19 of 19 patients), pulmonary abnormalities visualized by MR were judged to be concordant in their location and in the lesion type identified by both readers. In 22 lobes (11 of 19 patients), no abnormalities were present on either MR or HRCT (true negative). In 6 lobes (5 of 19 patients), ground glass opacity areas were detected on MRI but were not visible on HRCT (false positives). In 11 lobes (7 of 19 patients), MRI failed to detect ground glass opacity areas identified by HRCT. However, since the abnormalities were disseminated in these patients, accurate treatment decisions were possible in every case based on MRI. In one case MRI showed a central area of cavitation, which was not visualized by HRCT. 1
45. Peltola V, Ruuskanen O, Svedstrom E. Magnetic resonance imaging of lung infections in children. Pediatr Radiol. 2008;38(11):1225-1231. Review/Other-Dx N/A To illustrate MRI findings in children with pneumonia caused by Mycoplasma pneumoniae, Streptococcus pneumoniae, and other pathogens. No results stated in abstract. 4
46. Rieger C, Herzog P, Eibel R, Fiegl M, Ostermann H. Pulmonary MRI--a new approach for the evaluation of febrile neutropenic patients with malignancies. Support Care Cancer. 16(6):599-606, 2008 Jun. Observational-Dx 50 patients To determine the feasibility and sensitivity of magnetic resonance imaging (MRI) of the lung compared to HR-CT in immunocompromised patients with persistent fever in neutropenia and suspected pneumonia. Of 50 patients, 35 had pulmonary infiltration according to HR-CT; these were examined with MRI of the lungs. MRI showed a high correlation (91%) with the findings in HR-CT. Both HR-CT and MRI were feasible in 94% of the examined patients. In 12 of 35 patients, fungal pathogens were identified in microbiological testing. 2
47. Sodhi KS, Khandelwal N, Saxena AK, et al. Rapid lung MRI in children with pulmonary infections: Time to change our diagnostic algorithms. Journal of Magnetic Resonance Imaging. 43(5):1196-206, 2016 May. Experimental-Dx 75 patients To determine the diagnostic utility of a new rapid MRI protocol, as compared with computed tomography (CT) for the detection of various pulmonary and mediastinal abnormalities in children with suspected pulmonary infections. MRI with a new rapid MRI protocol demonstrated sensitivity, specificity, PPV, and NPV of 100% for detecting pulmonary consolidation, nodules (>3 mm), cyst/cavity, hyperinflation, pleural effusion, and lymph nodes. The kappa-test showed almost perfect agreement between MRI and multidetector CT (MDCT) in detecting thoracic abnormalities (k = 0.9). No statistically significant difference was observed between MRI and MDCT for detecting thoracic abnormalities by the McNemar test (P = 0.125). 2
48. Yikilmaz A, Koc A, Coskun A, Ozturk MK, Mulkern RV, Lee EY. Evaluation of pneumonia in children: comparison of MRI with fast imaging sequences at 1.5T with chest radiographs. Acta Radiol. 2011;52(8):914-919. Observational-Dx 40 patients To investigate the efficacy of chest MRI with fast imaging sequences at 1.5T for evaluating pneumonia in children by comparing MRI findings with those of chest radiographs. All consolidation, lung necrosis/abscess, bronchiectasis, and pleural effusion detected with chest radiographs were also detected with MRI. There was statistically substantial agreement between chest radiographs and MRI in detecting consolidation (k = 0.78) and bronchiectasis (k = 0.72) in children with pneumonia. The agreement between chest radiographs and MRI was moderate for detecting necrosis/abscess (k = 0.49) and fair for detecting pleural effusion (k = 0.30). 3
49. Yang S, Zhang Y, Shen J, et al. Clinical Potential of UTE-MRI for Assessing COVID-19: Patient- and Lesion-Based Comparative Analysis. Journal of Magnetic Resonance Imaging. 52(2):397-406, 2020 08. Observational-Dx 23 patients To evaluate the effectiveness of UTE-MRI for assessing COVID-19. There was no significant difference between the image quality of CT and UTE-MRI (CT vs. UTE-MRI: 4.3 ± 0.4 vs. 4.0 ± 0.5, P = 0.09). Moreover, both patient- and lesion-based interobserver agreement of CT and UTE-MRI for evaluating the image signs of COVID-19 were determined as excellent (ICC: 0.939-1.000, P < 0.05; Kendall's W: 0.894-1.000, P < 0.05.). In addition, the intermethod agreement of two image modalities for assessing the representative findings of COVID-19 including affected lobes, total severity score, ground glass opacities (GGO), consolidation, GGO with consolidation, the number of crazy paving pattern, and linear opacities, as well as pseudocavity were all determined as substantial or excellent (kappa: 0.649-1.000, P < 0.05; ICC: 0.913-1.000, P < 0.05). 2
50. Helm EJ, Matin TN, Gleeson FV. Imaging of the pleura. J Magn Reson Imaging 2010;32:1275-86. Review/Other-Dx N/A To focus on the contributions of CT, MRI, and PET to the management of pleural disease with discussion of their relative strengths and weaknesses. No results stated in the abstract. 4
51. Biederer J, Hintze C, Fabel M. MRI of pulmonary nodules: technique and diagnostic value. Cancer Imaging 2008;8:125-30. Review/Other-Dx N/A To outline  the capabilities of MRI for the detection and characterization of lung nodules. No results stated in the abstract. 4
52. Quarato CMI, Mirijello A, Lacedonia D, et al. Low Sensitivity of Admission Lung US Compared to Chest CT for Diagnosis of Lung Involvement in a Cohort of 82 Patients with COVID-19 Pneumonia. Medicina (Kaunas, Lithuania). 57(3), 2021 Mar 04. Observational-Dx 82 patients To estimate sensitivity of admission LUS for the detection of SARS-CoV-2 lung involvement using Chest-CT (Computed Tomography) as reference standard in order to assess LUS usefulness in ruling out COVID-19 pneumonia in the Emergency Department (ED). Global LUS sensitivity in detecting COVID-19 pulmonary lesions was 52%. LUS sensitivity ranged from 8% in case of focal and sporadic ground-glass opacities (mild disease), to 52% for a crazy-paving pattern (moderate disease) and up to 100% in case of extensive subpleural consolidations (severe disease), although LUS was not always able to detect all the consolidations assessed at Chest-CT. LUS sensitivity was higher in detecting a typical Chest-CT pattern (60%) and abnormalities showing a middle-lower zone predominance (79%). 1
53. Volpicelli G, Cardinale L, Fraccalini T, et al. Descriptive analysis of a comparison between lung ultrasound and chest radiography in patients suspected of COVID-19. The Ultrasound Journal. 13(1):11, 2021 Feb 26. Observational-Dx 139 patients To describe the comparison between LUS interpretation and CXR readings in the first approach to patients suspected of COVID-19. We analyzed 139 cases (55 women, mean age 59.1 ± 15.5 years old). The LUS vs CXR results disagreed in 60 (43.2%) cases. RT-PCR was positive in 88 (63.3%) cases. In 45 cases, a CT scan was also performed and only 4 disagreed with LUS interpretation versus 24 in the comparison between CT and CXR. In 18 cases, LUS detected signs of COVID-19 pneumonia (high and intermediate probabilities) while CXR reading was negative; in 14 of these cases, a CT scan or a RT-PCR-positive result confirmed the LUS interpretation. In 6 cases, LUS detected signs of alternative diagnoses to COVID-19 pneumonia while CXR was negative; in 4 of these cases, CT scan confirmed atypical findings. 2
54. Bouhemad B, Zhang M, Lu Q, Rouby JJ. Clinical review: Bedside lung ultrasound in critical care practice. [Review] [61 refs]. Critical Care (London, England). 11(1):205, 2007. Review/Other-Dx N/A To review the performance of bedside lung ultrasound for diagnosing pleural effusion, pneumothorax, alveolar-interstitial syndrome, lung consolidation, pulmonary abscess and lung recruitment/derecruitment in critically ill patients with acute lung injury. No results stated in abstract. 4
55. Baber CE, Hedlund LW, Oddson TA, Putman CE. Differentiating empyemas and peripheral pulmonary abscesses: the value of computed tomography. Radiology. 1980; 135(3):755-758. Review/Other-Dx 13 patients To determine the value of CT in differentiating empyemas and peripheral pulmonary abscesses. After CT, 8 patients were diagnosed as having abscesses and 5 as having empyemas. Abscesses had an irregular shape and a relatively thick wall which was not uniformly wide and did not have a discrete boundary between the lesion and lung parenchyma. In contrast, empyemas had a regularly shaped lumen, a smooth inner surface, and a sharply defined border between the lesion and lung. CT studies can help to distinguish between empyemas and abscesses, and treatment can be started sooner in difficult cases. 4
56. Arenas-Jimenez JJ, Garcia-Garrigos E, Escudero-Fresneda C, et al. Early and delayed phases of contrast-enhanced CT for evaluating patients with malignant pleural effusion. Results of pairwise comparison by multiple observers. Br J Radiol 2018;91:20180254. Observational-Dx 36 patients To compare images from early and delayed phases of contrast-enhanced thoracic CT for assessing pleural thickening or nodules in a series of patients with malignant pleural effusions. Mean attenuation of pleural lesions was significantly higher in the delayed phase (76.0 ± 25.1 vs 57.5 ± 20.7, p < 0.001). Mean score and score of individual images was statistically significant better for the delayed phase for all observers. In the paired analysis, all the readers preferred the delayed phase over the early phase in 77.8 to 91.7% of the cases. 2
57. Davis SD, Henschke CI, Yankelevitz DF, Cahill PT, Yi Y. MR imaging of pleural effusions. J Comput Assist Tomogr 1990;14:192-8. Observational-Dx N/A To investigate the in vivo magnetic resonance (MR) characteristics of pleural effusions, MR imaging was performed on 22 patients who also underwent thoracentesis No results stated in the abstract 2
58. Soni NJ, Franco R, Velez MI, et al. Ultrasound in the diagnosis and management of pleural effusions. [Review]. J Hosp Med. 10(12):811-6, 2015 Dec. Review/Other-Dx N/A To provide an overview of how point-of-care ultrasound can be utilized by hospitalists in the care of patients with pleural effusions No results stated in abstract 4
59. Findley LJ, Sahn SA. The value of chest roentgenograms in acute asthma in adults. Chest. 1981; 80(5):535-536. Review/Other-Dx 90 roentgenograms To determine the frequency of roentgenographic abnormalities in adults with acute asthma seen in an emergency room and to assess its value in guiding management. Chest roentgenograms were obtained in 90 episodes of acute asthma in adults coming to an emergency room. of these 90 roentgenograms, 50 (55 percent) were interpreted as normal, 33 (37 percent) showed hyperinflatlon, and 6 (7 percent) showed minimal Interstitial abnormalities unchanged from previous roentgenograms. One (1 percent) showed a new alveolar infiltrate in a patient with allergic aspergillosis. There was no significant correlation between chest roentgenogram interpretation and hospitalization. Our data show that the incidence of specific abnormalities on chest roentgenogram in adults with uncomplicated acute asthma Is low and suggests that the Information obtained from the roentgenogram is rarely helpful to outpatient management. 4
60. Ash SY, Diaz AA. The role of imaging in the assessment of severe asthma. [Review]. Current Opinion in Pulmonary Medicine. 23(1):97-102, 2017 01. Review/Other-Dx N/A To summarize the most recent evidence related to imaging and severe asthma, both with regard to advances in imaging research and to their current and potential clinical implications. Recent work in imaging in severe asthma has principally been using computed tomography (CT) and magnetic resonance imaging (MRI), as well as the integration of the two. Some of the most notable findings include the use of CT imaging biomarkers to create unique clusters of asthmatics, and the use of co-registration to link CT images of airways with regional variation in ventilation in MRI. In addition, temporal studies have shown that some the ventilation defects found using MRI in asthmatics are intermittent and others are persistent, but both are associated with lower lung function. 4
61. White CS, Cole RP, Lubetsky HW, Austin JH. Acute asthma. Admission chest radiography in hospitalized adult patients. Chest. 1991; 100(1):14-16. Review/Other-Dx 54 patients To examine the effect of admission CXR on immediate management decisions after unsuccessful therapy in the emergency ward Major radiographic abnormalities were found in 20 (34 percent) of 58 occasions. These abnormalities included focal parenchymal opacities, IIM, enlarged cardiac silhouette, pulmonary vascular congestion, new solitary pulmonary nodule and pneumothorax. Subsequent antibiotic use correlated with radiographic focal opacities or IIM, even in afebrile patients, but did not correlate with elevated blood leukocyte count. 4
62. Petheram IS, Kerr IH, Collins JV. Value of chest radiographs in severe acute asthma. Clin Radiol. 1981; 32(3):281-282. Observational-Dx 117 patients To assess the value of CXRs in determining the frequency and importance of radiological abnormalities in adults with severe acute asthma. 92 (70%) of the admission 3
63. Rangelov BA, Young AL, Jacob J, et al. Thoracic Imaging at Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review. [Review]. International Journal of Copd. 15:1751-1787, 2020. Review/Other-Dx 5,047 articles To identify studies that performed imaging of the thorax at COPD exacerbation. We included 51 from a total of 5,047 articles which met all our inclusion criteria. No results stated in the abstract. 4
64. Wedzicha JAEC-C, Miravitlles M, Hurst JR, et al. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J 2017;49. Review/Other-Dx N/A To provide clinical recommendations for treatment of chronic obstructive pulmonary disease (COPD) exacerbations.Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. 1) a strong recommendation for noninvasive mechanical ventilation of patients with acute or acute-on-chronic respiratory failure; 2) conditional recommendations for oral corticosteroids in outpatients, oral rather than intravenous corticosteroids in hospitalised patients, antibiotic therapy, home-based management, and the initiation of pulmonary rehabilitation within 3 weeks after hospital discharge; and 3) a conditional recommendation against the initiation of pulmonary rehabilitation during hospitalisation. 4
65. Sherman S, Skoney JA, Ravikrishnan KP. Routine chest radiographs in exacerbations of chronic obstructive pulmonary disease. Diagnostic value. Arch Intern Med. 1989; 149(11):2493-2496. Review/Other-Dx 54 patients To review the impact of admission CXR on in-hospital management of patients with acute asthma. Major radiographic abnormalities were found in 20 (34%) of 58 occasions. These abnormalities included focal parenchymal opacities, increased interstitial markings, enlarged cardiac silhouette, pulmonary vascular congestion, new solitary pulmonary nodule and pneumothorax. Subsequent antibiotic use correlated with radiographic focal opacities or increased interstitial markings, even in afebrile patients, but did not correlate with elevated blood leukocyte count. Based on the evidence of in-hospital alteration of management independent of elevated blood leukocyte count and body temperature, the authors recommend that CXRs be obtained for all adult patients admitted because of acute asthma. 4
66. Ramsdell J, Narsavage GL, Fink JB, American College of Chest Physicians' Home Care Network Working G. Management of community-acquired pneumonia in the home: an American College of Chest Physicians clinical position statement. Chest 2005;127:1752-63. Review/Other-Dx N/A To  provide recommendations on the various aspects of home care for patients with this condition. No results stated in the abstract 4
67. Harvey HB, Gilman MD, Wu CC, et al. Diagnostic yield of recommendations for chest CT examination prompted by outpatient chest radiographic findings. Radiology. 275(1):262-71, 2015 Apr. Observational-Dx 29,138 patients To evaluate the diagnostic yield of recommended chest computed tomography (CT) prompted by abnormalities detected on outpatient chest radiographic images. There were 4.5% (1316 of 29138 [95% confidence interval {CI}: 4.3%, 4.8%]) of outpatient chest radiographic examinations that contained a recommendation for chest CT examination, and increasing patient age (P < .001) and positive smoking history (P = .001) were associated with increased likelihood of a recommendation for chest CT examination. Of patients within this subset who met inclusion criteria, 65.4% (691 of 1057 [95% CI: 62.4%, 68.2%) underwent a chest CT examination within the year after the index chest radiographic examination. Clinically relevant corresponding abnormalities were present on chest CT images in 41.4% (286 of 691 [95% CI: 37.7%, 45.2%]) of cases, nonclinically relevant corresponding abnormalities in 20.6% (142 of 691 [95% CI: 17.6%, 23.8%]) of cases, and no corresponding abnormalities in 38.1% (263 of 691 [95% CI: 34.4%, 41.8%]) of cases. Newly diagnosed, biopsy-proven malignancies were detected in 8.1% (56 of 691 [95% CI: 6.2%, 10.4%]) of cases. 2
68. Little BP, Gilman MD, Humphrey KL, et al. Outcome of recommendations for radiographic follow-up of pneumonia on outpatient chest radiography. AJR. American Journal of Roentgenology. 202(1):54-9, 2014 Jan. Review/Other-Dx 29,138 outpatient To examine the incidence of important pulmonary pathology revealed during follow-up imaging of suspected pneumonia on outpatient chest radiography. Compliance with follow-up imaging recommendations was 76.7%. In nine of 618 cases (1.5%), a newly diagnosed malignancy corresponded to the abnormality on chest radiography initially suspected to be pneumonia. In 23 of 618 cases (3.7%), an alternative nonmalignant disease corresponded with the abnormality on chest radiography initially suspected to be pneumonia. Therefore, in 32 of 618 patients (5.2%), significant new pulmonary diagnoses were established during follow-up imaging of suspected pneumonia. 4
69. Macdonald C, Jayathissa S, Leadbetter M. Is post-pneumonia chest X-ray for lung malignancy useful? Results of an audit of current practice. Internal Medicine Journal. 45(3):329-34, 2015 Mar. Observational-Dx 302 patients To detect underlying lung malignancy, which can be difficult to identify initially when an acute infiltrate is present on X-ray. We conducted a study on the use of follow-up chest X-rays after an admission with CAP to determine the yield of suspected or diagnosed cancer. A total of 302 patients was included. Of these, 53% received a follow-up chest X-ray within 6-12 weeks after admission. A total of six patients (2.0%) was diagnosed with lung cancer based on a chest X-ray within 6-12 weeks after admission. After a median period of follow up of 19.5 months, a further five patients who had normal chest X-ray were diagnosed with lung malignancy. 2
70. Holmberg H, Kragsbjerg P. Association of pneumonia and lung cancer: the value of convalescent chest radiography and follow-up. Scand J Infect Dis 1993;25:93-100. Observational-Dx 232 inpatients To investigate the mode of clinical onset of pulmonary carcinoma, 232 inpatients with this diagnosis were also studied. The findings may be summarized as follows: 1) 13/1011 pneumonia patients were found to have previously undiagnosed pulmonary carcinoma; 2) many of these carcinomas (8/13) were disclosed by an acute chest X-ray; 3) pulmonary carcinoma was found by convalescent chest X-ray in 2/88 patients not feeling well and in 2/524 patients feeling well at follow-up, and none of these 4 patients benefitted from the carcinoma diagnosis; 4) ESR was of no value in detecting underlying pulmonary carcinoma at follow-up in patients with pneumonia; 5) of the 232 patients with pulmonary carcinoma, 29 (12.5%) presented with an acute respiratory tract infection; 6) most of these latter patients did not recover as expected and their correct diagnosis was made based on a chest X-ray performed because of persistent symptoms. We suggest that patients with radiologically verified pneumonia undergo clinical examination or are interviewed 4-5 weeks after the onset. If signs or symptoms of respiratory disease persist, chest X-ray should be performed. We consider, however, that routine convalescent chest radiography with the aim of detecting any underlying pulmonary tumour could be omitted if the patient has completely recovered 1 month after the acute onset of illness. 2
71. Marrie TJ. Pneumonia and carcinoma of the lung. J Infect 1994;29:45-52. Review/Other-Dx 1269 patients To discuss the review of Pneumonia and carcinoma of the lung in a prospective study. No results stated in the abstract. 4
72. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. American Journal of Respiratory & Critical Care Medicine. 200(7):e45-e67, 2019 10 01. Review/Other-Dx N/A To provide evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia. The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of site of care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Although some recommendations remain unchanged from the 2007 guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions 4
73. Mortensen EM, Copeland LA, Pugh MJ, et al. Diagnosis of pulmonary malignancy after hospitalization for pneumonia. American Journal of Medicine. 123(1):66-71, 2010 Jan. Observational-Dx 40,744 patients To assess the frequency of the diagnosis of pulmonary malignancy, and to identify risk factors for pulmonary malignancy following hospitalization for pneumonia. Of 40,744 patients hospitalized with pneumonia, 3760 (9.2%) patients were diagnosed with pulmonary malignancy after their index pneumonia admission. Median time to diagnosis was 297 days, with only 27% diagnosed within 90 days of admission. Factors significantly associated with a new diagnosis of pulmonary malignancy included history of chronic pulmonary disease, any prior malignancy, white race, being married, and tobacco use. Increasing age, Hispanic ethnicity, need for intensive care unit admission, and a history of congestive heart failure, stroke, dementia, or diabetes with complications were associated with a lower incidence of pulmonary malignancy. 2
74. Tang KL, Eurich DT, Minhas-Sandhu JK, Marrie TJ, Majumdar SR. Incidence, correlates, and chest radiographic yield of new lung cancer diagnosis in 3398 patients with pneumonia. Archives of Internal Medicine. 171(13):1193-8, 2011 Jul 11. Observational-Dx 3398 patients To determine the incidence and correlates of new lung cancer and the diagnostic yield of new lung cancer by chest radiography in patients with pneumonia. There were 3398 patients; 59% were 50 years or older, 52% were male, and 17% were smokers. Half (49%) were admitted to hospital. At 90 days, 36 patients (1.1%) had new lung cancer; at 1 year, 57 patients (1.7%); and over 5 years, 79 patients (2.3%). The median time to diagnosis was 109 days (interquartile range, 27-423 days). Characteristics independently associated with lung cancer included age 50 years or older (adjusted hazard ratio [aHR], 19.0; 95% confidence interval [CI], 5.7-63.6), male sex (aHR, 1.8; 95% CI, 1.1-2.9), and smoking (aHR, 1.7; 95% CI, 1.0-3.0). Of the patients, 1354 (40%) had follow-up chest radiographs within 90 days, and the diagnostic yield of lung cancer was 2.5%; if radiographs were restricted to patients 50 years or older, the yield would have been 2.8%. 2
75. Humphrey KL, Gilman MD, Little BP, et al. Radiographic follow-up of suspected pneumonia: survey of Society of Thoracic Radiology membership. Journal of Thoracic Imaging. 28(4):240-3, 2013 Jul. Observational-Dx 209 radiologists To examine the current radiographic follow-up recommendations of thoracic radiologists after detection of a new opacity, suspected to be "pneumonia," on chest radiography. Of the 209 radiologists who responded, 42% "always" recommended follow-up radiographs for new opacities detected on chest radiographs, 55% "sometimes" recommended follow-up, and 2% "never" recommended follow-up. Univariate logistic regression analysis revealed that "years in practice" (P=0.0043) and "number of outpatient posterior-anterior and lateral chest radiographs interpreted per week" (P=0.027) were significant predictors of the recommendation practices. In addition, the multivariable logistic regression analysis pointed to the type of practice (academic vs. private) as an additional independent predictor of the recommendation practices (P=0.0294). The recommendations of those radiologists recommending follow-up "sometimes" were most often influenced by the radiographic appearance of the opacity and patient age. Only 4% reported an institutional policy. 2
76. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Measuring Sex, Gender Identity, and Sexual Orientation. In: Becker T, Chin M, Bates N, eds. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US) Copyright 2022 by the National Academy of Sciences. All rights reserved.; 2022. Review/Other-Dx N/A Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. No abstract available. 4
77. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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