When should a chest x-ray be used to evaluate acute-onset productive cough for adults?

Abstract

Even though the most common reason to order a chest x-ray in the evaluation of an acute-onset, productive cough is to rule out pneumonia, there is no strong evidence to help a physician decide when to order this chest x-ray. However, acute cough patients who have rhinorrhea, sore throat, respiratory rate ≤25 breaths per minute, temperature <100°F, and the absence of night sweats, myalgia, and all-day sputum production, have minimal to no risk of pneumonia and thus do not need a chest x-ray (strength of recommendation: A, based on a clinical decision rule validated in 2 high-quality cohort studies).