Gómez-Gil Esther, Trilla Antoni, Corbella Barbara, Fernández-Egea Emilio, Luburich Patricio, de Pablo Joan, Ferrer Raldúa José, Valdés Manuel
Psychiatry and Clinical Psychology Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain.
Gen Hosp Psychiatry. 2002 Mar-Apr;24(2):110-3. doi: 10.1016/s0163-8343(01)00179-7.
To make clinically relevant recommendations for chest X-ray testing in acute psychiatric admissions, this study examined the current practice of this screening test in patients admitted to a University Hospital. The records of the 332 first consecutive admissions to the psychiatric ward were assessed. In 200 patients (60%) a chest X-ray was requested. The X-ray film was normal in 81.5% of patients. The remaining subjects presented abnormalities: nonrelevant in twenty-seven (13.5% of the total), and relevant in eleven (5.5%). Since all these relevant abnormalities were already known, in no cases was the test followed by changes in therapy or by additional diagnostic procedures. In almost all cases this screening test was of no practical value. Our findings challenge the systematic indication of chest X-ray in acute psychiatric patients, and suggest that the number of tests performed and the cost of medical care could be reduced by a more efficient use of past medical history and physical examination criteria, without compromising the quality of patient care.
为了对急性精神科住院患者的胸部X光检查提出具有临床相关性的建议，本研究调查了某大学医院住院患者中该项筛查检查的当前实践情况。对精神科病房连续收治的首批332例患者的病历进行了评估。其中200例患者（60%）进行了胸部X光检查。81.5%的患者X光片显示正常。其余患者存在异常情况：27例（占总数的13.5%）为无关异常，11例（5.5%）为相关异常。由于所有这些相关异常情况早已为人所知，因此在任何病例中，该项检查之后均未导致治疗方案改变或进行额外的诊断程序。几乎在所有病例中，这项筛查检查都没有实际价值。我们的研究结果对急性精神科患者胸部X光检查的系统性指征提出了质疑，并表明通过更有效地利用既往病史和体格检查标准，可以减少检查次数和医疗费用，同时不影响患者护理质量。
