CLINICAL IMPLICATIONS OF CHEST X-RAY IN ASSESMENT OF PNEUMONIA AND EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN CONJUNCTION WITH PRACTICE OF ANTIBIOTIC PRESCRIPTION IN THE EMERGENCY DEPARTMENT
Translated title
Den kliniske relevans af røntgen af thorax ved vurdering af pneumoni og akut eksacerbation af kronisk obstruktiv lungesygdom og sammenhængen med antibiotikaordination på akutafdelingen
Term
5. Term (Master thesis)
Education
Publication year
2026
Submitted on
2026-01-01
Pages
24
Abstract
Background: Chest X-ray (CXR) is a frequently performed diagnostic imaging examination. It is commonly used as an early diagnostic tool in the emergency departments (ED) for suspected conditions such as pneumonia, pneumothorax, pleural effusion, or suspected cardiac decompensation. In clinical practice, the use of CXR does not always follow a systematic approach bases on clinical and paraclinical findings, which may lead to unnecessary examinations, increased resource use, and radiation exposure. In this context, the aim of this study was to investigate whether the final CXR report altered the initial antibiotic treatment in patients with pneumonia and exacerbation of chronic obstructive pulmonary disease (ECOPD). Method: This study was designed as a retrospective quality-assurance study based on review of medical records from 300 patients admitted to the ED at the North Regional Hospital during the period from January 1, 2022, to December 31, 2024. For each patient, data on clinical manifestations and radiological findings were extracted from medical records and systematically analyzed to determine the diagnostic contribution of CXR and its influence on antibiotic treatment decisions. Results: In 51 % of patients with pneumonia and 29 % of patients with ECOPD, the same antibiotic regimen initiated before CXR was continued after the results of the examination were available to the clinician. Radiographic infiltrates were identified in 32 % of patients for pneumonia and 14 % of patients with ECOPD. Furthermore, among patients with CXR-verified infiltrates, 92% of those with pneumonia and 90% of those with ECOPD continued their initial antibiotic treatment. Conclusion: This study demonstrated that the CXR report in the ED infrequently led to changes 2 in the antibiotic treatment already started prior to performance of the CXR based on the initial clinical assessment. It can be considered whether clear and consistent guidelines for use of CXR potentially can reduce unnecessary examinations and radiation exposure, while optimizing the use of healthcare resources without compromising the quality of patient care.
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