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    Patent Pending

    Newsom Score for Non-traumatic Chest Pain

    Rules out need for chest x-ray in chest pain patients (non-traumatic).
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    INSTRUCTIONS

    Use in patients presenting to the emergency department for non-traumatic chest pain.

    When to Use
    Pearls/Pitfalls
    Why Use

    Patients presenting to the emergency department for non-traumatic chest pain.

    • Application of this decision tool would have missed five clinically relevant diagnoses in the study population: three pneumonias and two pleural effusions.

    • The prevalence of clinically relevant ED findings on chest x-ray in the study population was 6.4%. In populations where prevalence is higher, negative predictive value (98.4% in the study) would decrease (Newsom 2018).
    • Can potentially safely eliminate unnecessary x-ray in patients presenting to EDs with non-traumatic chest pain (92.9% sensitive, NPV 98.4% for clinically relevant ED findings on chest x-ray).
    • In the validation study, application of the score would have decreased chest x-ray usage by 28.9%.
    • The study authors estimate a potential decrease of $58 million per year in healthcare costs as a result of the potential decrease number of chest x-rays performed with application of the clinical decision tool. 
    Criteria

    Presence of ≥1 means the patient is not low risk:

    Diagnostic Result:

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    Evidence
    Creator Insights

    Critical Actions

    • Consider prevalence of clinically significant chest x-ray findings in your population in comparison to the study population before applying the clinical decision tool to your practice. 
    • Though the criteria had excellent sensitivity and NPV for the study population, it did miss cases of pneumonia and pleural effusions. If clinical suspicion for these diagnosis is high despite absence of study criteria, consider performing chest x-ray. 
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    About the Creator
    Dr. Case K. Newsom
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