| Hartnell GG et al, 1993, UK | Chest radiographs from 18 patient with aortic dissection, and 25 patients with acute myocardial infarction | Case control study | Sensitivity of chest radiographs interpretation | 88.9% | Unclear how MI chest radiographs were obtained |
| Chest radiographs reviewed by consultant radiologists | | 1st observer | 72.2% | Only two radiologists interpreted the radiographs. There was a large interobserver variability. It would have been more informative if a larger number of radiologists had been used. |
| | | Sensitivity observer 2 | | Radiologists knew that around half the patients had a dissection and half an MI |
| | | | | This study does not use A&E doctors |
| Vu KH et al, 1994, Australia | 42 patients with diagnosis of aortic dissection | Retrospective cohort | The following results are calculated using 19 patients with dissection (16 confirmed by surgery/necropsy, but also includes three patients who died without necropsy) | 52.6% | Gold standard not applied to all patients— only 16 had confirmation of dissection at surgery or on postmortem examination. No information given regarding the diagnostic imaging for the other 26. |
| | | Sensitivity wide mediastinum | 47% | Retrospective review open to bias |
| | | Sensitivity dilated aortic arch | 17% | Chest radiographs reported by a senior radiologist—not A&E doctors |
| | | Sensitivity displacement of calcified aortic plaques | 5% | Unclear how patients were identified retrospectively |
| | | Tracheal deviation | 15% | |
| | | Pleural effusion | 21% | |
| | | Cardiomegally | | |
| Hennessy TG et al, 1996, Ireland | 55 consecutive patients referred with suspected thoracic dissection to a cardiology department | Retrospective cohort | Sensitivity wide mediastinum | 65.7% | Retrospective review using case notes. |
| 35 of 55 had a dissecting thoracic aneurysm | | Normal chest radiograph | 14 of 35 normal | Unclear who reported chest radiographs |
| | | Other abnormality | 7 of 35 showed another abnormality | Only includes those referred to cardiology department. It is unclear which investigations each patient had undergone before referral |
| | | | | Not clear whether gold standard applied to all patients |
| Klompas M, 2002, USA | Patients with clinically suspected aortic dissection or confirmed dissection | Literature review including prospective and retrospective cohorts in 21 studies | Abnormal aortic contour | Sensitivity 61% (CI 56 to 84) | Search terms not clearly stated. It would not be possible to repeat this search from the information given |
| | | Pleural effusion | Sensitivity 16% (CI 12 to 21) | Vast majority of papers are retrospective reviews of patients with known dissections, unblinded and heavily open to bias |
| | | Displaced intimal calcification | Sensitivity 9% (CI 6 to 13) | Not all studies looked at the same chest radiograph findings |
| | | Wide mediastinum | Sensitivity 64% (CI 44 to 80) | |
| | | Abnormal chest radiograph | Sensitivity 90% (CI 87 to 92) | |