Utility of Chest Radiography in Emergency Department Patients Presenting With Syncope

Matthew L. Wong, MD, MPH; David Chiu, MD; Nathan I Shapiro, MD, MPH; Shamai A Grossman, MD, MS


Western J Emerg Med. 2016;17(6):698-701. 

In This Article


There are a number of limitations to this study. The discretionary performance of CXRs is a limitation that certainly introduces bias. Table 1 demonstrates that patients who did not have a CXR performed were much less likely to have an adverse event compared to the groups that had a normal CXR, as well as abnormal CXR. But at the same time the discretionary ordering reflects actual clinical practice. It seems unrealistic if not unethical to mandate diagnostic studies with ionization radiation for patients for whom the treating team does not think it justifiable or potentially helpful. Other limitations include the use of a single institution for a test site, which may limit the generalizability of the conclusions of this study. Furthermore, the sample size of this cohort is relatively small, as was the abnormal CXR rate, and there was a lack of long-term follow up in these patients.