Stroke code chest radiographs are not useful

Background: Routine chest radiographs at the time of hospital admission are not recommended for stroke patients in the absence of pulmonary symptoms. The usefulness of the test in patients being evaluated by a stroke team for hyperacute stroke symptoms was assessed. Methods: Demographic information, chest radiograph results, and the impact of the test on the emergency department (ED) management of a consecutive series of patients evaluated by a stroke code team between 2005-2006 were retrospectively collected and analyzed. Results: Chest radiographs were obtained in the ED for 92% of patients (n = 113). The sole indication for the test was 'stroke' in 91% (one patient had a normal study performed for chest pain; the remainder were performed in association with endotracheal intubation). Chest radiographs were completely normal in 70% with 25.2% having incidental and 3.8% having potentially relevant findings. No patient had a finding that otherwise affected their ED management. Conclusion: Routine chest radiographs obtained as part of the emergent evaluation of patients with acute stroke symptoms rarely provide useful information, expose the patient to unnecessary radiation, add costs, and can interfere with other more critical parts of the patient's emergent assessment.