• Patrick J Sylvester, Jonathon Stewart, Austin Schoeffler, Joshua Aalberg, Katherine M Hunold, Jeffrey M Caterino, and Jason J Bischof.
• Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
• J Emerg Med. 2020 Sep 1; 59 (3): 396-402.

BackgroundThe 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.ObjectiveTo determine whether CT imaging of the chest increases identification of clinically significant results compared with chest radiography (CXR) in patients with cancer.MethodsThis 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.ResultsFrom 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).ConclusionsCompared with CXR, CT imaging of the chest identified significantly more clinically relevant findings requiring attention and consequently affecting clinical decision making.Copyright © 2020 Elsevier Inc. All rights reserved.

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