The impact of routine chest radiography on the management of patients admitted from an emergency service.
Adult patients entering a hospital usually undergo a routine admission chest radiographic examination (RACXR). Recently, this practice has been questioned. The clinical course of 188 patients admitted to an adult medical service from the emergency area of an inner city hospital was assessed prospectively. Each of these patients underwent RACXR, ie, the only indication for the examination was admission to the hospital. Four subpopulations considered to be at high risk for treatment-altering radiographic abnormalities were defined prospectively: age of 65 years or older, cigarette smokers, altered mental status, and human immunodeficiency virus (HIV) positivity. RACXR abnormalities were significantly more common in the subpopulations at high risk (104/127, 82%) than in the population at low risk (37/61, 61%) (P less than .01). Abnormalities on RACXR led to altered treatment in five (3%) of the 188 inpatients. Each of these five patients was a member of a subpopulation at high risk (5/127, 4%). Because results suggest that various clinical considerations may affect the yield of RACXR, it is proposed that a blanket recommendation to eliminate RACXR is premature.
White
C S
CS
Department of Radiology, Columbia-Presbyterian Medical Center, New York, NY 10032.
Austin
J H
JH
Lubetsky
H W
HW
Cole
R P
RP
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003955:Diagnostic Tests, Routine; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006679:HIV Seropositivity; D006746:Hospital Bed Capacity, 500 and over; D006760:Hospitalization; D006801:Humans; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D012307:Risk Factors; D012907:Smoking