Chest radiography in general practice: indications, diagnostic yield and consequences for patient management.
BACKGROUND
Chest radiography (CXR) is frequently performed in Western societies. There is insufficient knowledge of its diagnostic value in terms of changes in patient management decisions in primary care.


OBJECTIVE
To assess the influence of CXR on patient management in general practice.


METHODS
Prospective cohort study.


METHODS
Seventy-eight GPs and three general hospitals in the Netherlands.


METHODS
Patients (n = 792) aged > or =18 years referred by their GPs for CXR were included. The main outcome was change in patient management assessed by means of questionnaires filled in by GPs before and after CXR.


RESULTS
Mean age of the patients was 57.3+/-16.2 years and 53% were male. Clinically relevant abnormalities were found in 24% of the CXRs. Patient management changed in 60% of the patients following CXR. Main changes included: fewer referrals to a medical specialist (from 26 to 12%); reduction in initiation or change in therapy (from 24 to 15%); and more frequent reassurance (from 25 to 46%). However, this reassurance was not perceived as such in a quarter of these patients. A change in patient management occurred significantly more frequently in patients with complaints of cough (67%), those who exhibited abnormalities during physical examination (69%), or those with a suspected diagnosis of pneumonia (68%).


CONCLUSIONS
Patient management by the GP changed in 60% of patients following CXR. CXR substantially reduced the number of referrals and initiation or change in therapy, and more patients were reassured by their GP. Thus, CXR is an important diagnostic tool for GPs and seems a cost-effective diagnostic test.
Speets
Anouk M
AM
Department of Radiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
van der Graaf
Yolanda
Y
Hoes
Arno W
AW
Kalmijn
Sandra
S
Sachs
Alfred Pe
AP
Rutten
Matthieu Jcm
MJ
Gratama
Jan Willem C
JW
Montauban van Swijndregt
Alexander D
AD
Mali
Willem Pthm
WP
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics; D005194:Family Practice / Q000191:economics; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000191:economics / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000191:economics / Q000706:statistics & numerical data*; D012017:Referral and Consultation