Newsom C, et al. - Researchers aimed at prospectively validating and refining previously published criteria to determine the potential utility of chest X-ray (CXR) in the evaluation and management of patients presenting to the Emergency Department (ED) with nontraumatic chest pain (CP). In a prospective observational study of patients presenting to three EDs in the United States with a chief complaint of nontraumatic CP, 1,111 patients were enrolled and 1,089 CXRs were analyzed. The refined decision rule showed a sensitivity of 92.9% and specificity of 30.4% to predict clinically relevant findings on CXR, with a negative predictive value (NPV) of 98.4%. Findings support that in the setting of nontraumatic CP in the ED, CXR has a low clinical yield and that the refined clinical decision rule has a favorable sensitivity and NPV in a patient population with low incidence of disease.