We evaluated the impact of routine chest x-ray films, obtained on admission, on the treatment of patients on internal medicine wards of the Veterans Administration Medical Center, Long Beach, California--a population known to have a high prevalence of cardiopulmonary disease. The reasons for ordering chest films were determined prospectively, and three Department of Medicine faculty members reviewed the charts of admitted patients to determine the impact of chest-film results on patient care. Routine chest x-ray films were ordered for 294 (60 per cent) of the 491 patients studied. Abnormalities were noted in 106 (36 per cent) of these 294 patients. The findings were previously known, chronic, and stable in 86 patients; they were new in only 20. Treatment was changed because of chest-film results in only 12 (4 per cent) of the patients. In only one of these patients would appropriate treatment probably have been omitted if a chest film had not been obtained, and the patient's outcome was not improved by the treatment instituted. We conclude that the impact of routine admission chest x-ray films on patient care is very small, even in a population with a high prevalence of cardiopulmonary disease. We recommend that such films not be ordered solely because of admission.
This article has been cited by other articles:
Tigges, S., Roberts, D. L., Vydareny, K. H., Schulman, D. A.
(2004). Routine Chest Radiography in a Primary Care Setting. Radiology
233: 575-578
[Abstract][Full Text]
Tierney, W. M.
(1996). Feedback of Performance and Diagnostic Testing: Lessons from Maastricht. Med Decis Making
16: 418-419
McDonald, C. J., Overhage, J. M., Tierney, W. M., Abernathy, G. R., Dexter, P. R.
(1996). The Promise of Computerized Feedback Systems for Diabetes Care. ANN INTERN MED
124: 170-174
[Abstract][Full Text]
Murphy, D. J., Povar, G. J., Pawlson, L. G.
(1994). Setting Limits in Clinical Medicine. Arch Intern Med
154: 505-512
[Abstract]
Velanovich, V.
(1993). How Much Routine Preoperative Laboratory Testing Is Enough?. American Journal of Medical Quality
8: 145-151
[Abstract]
Sherman, S., Skoney, J. A., Ravikrishnan, K. P.
(1989). Routine Chest Radiographs in Exacerbations of Chronic Obstructive Pulmonary Disease: Diagnostic Value. Arch Intern Med
149: 2493-2496
[Abstract]
Berlowitz, D. R., Ghalill, K., Moskowitz, M. A.
(1989). The Use of Follow-up Chest Roentgenograms Among Hospitalized Patients. Arch Intern Med
149: 821-825
[Abstract]
Spiegel, J. S., Shapiro, M. F., Berman, B., Greenfield, S.
(1989). Changing Physician Test Ordering in a University Hospital: An Intervention of Physician Participation, Explicit Criteria, and Feedback. Arch Intern Med
149: 549-553
[Abstract]
Boisaubin, E. V.
(1988). Cost Containment and Quality Care-Reply. JAMA
259: 3131-3131
[Abstract]
Owens, M. W., Kinasewitz, G. T., Lambert, R. S., Matthews, W. H., Payne, D. K., George, R. B.
(1987). Influence of Spirometry and Chest Roentgenography on the Management of Pulmonary Outpatients. Arch Intern Med
147: 1966-1969
[Abstract]
JOCHELSON, M. S., ALTSCHULER, J., STOMPER, P. C.
(1986). The Yield of Chest Radiography in Febrile and Neutropenic Patients. ANN INTERN MED
105: 708-709
[Abstract]
Heckerling, P. S.
(1986). The Need for Chest Roentgenograms in Adults With Acute Respiratory Illness: Clinical Predictors. Arch Intern Med
146: 1321-1324
[Abstract]
TAPE, T. G., MUSHLIN, A. I.
(1986). Diagnostic Decision: The Utility of Routine Chest Radiographs. ANN INTERN MED
104: 663-670
[Abstract]
Campbell, T. L.
(1985). Routine Urinalysis: Is the Dipstick Enough?. JAMA
254: 1723-1723
[Abstract]
Angell, M.
(1985). Cost Containment and the Physician. JAMA
254: 1203-1207
[Abstract]
Previous
