Jasper A, Gibikote S, Kirupakaran H, Christopher D J, Mathews P
Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Staff-Student Health Services, Christian Medical College, Vellore, Tamil Nadu, India.
J Postgrad Med. 2020 Apr-Jun;66(2):90-93. doi: 10.4103/jpgm.JPGM_462_19.
Chest radiographs have been used worldwide as a screening tool before employment and training, by various healthcare and other government and nongovernment institutions. Many studies done in the past have demonstrated a relatively low yield for tuberculosis detection and therefore, the authors have questioned this practice.
To compare the value of the preadmission/employment chest radiograph in two groups, namely, those who have been previously exposed to a healthcare setting (post-exposure group) and those who have not been exposed (pre-exposure group) and to determine if there is a significant difference in tuberculosis detection between these two groups.
A retrospective review of the reports of the chest radiographs of all candidates appearing for admission to various undergraduate and postgraduate courses in our institute between 2014 and 2017 was performed.
The various abnormalities detected were recorded and the findings in the two groups were compared.
Chi-square test was used to compare between two group proportions.
Thirty out of 4333 (0.69%) candidates in the pre-exposure group and 53 out of 3379 (1.57%) candidates in the post-exposure group showed abnormalities on chest radiographs involving the lung parenchyma, mediastinum, heart, or pleura. In the pre-exposure group, six (0.14%) were found to have underlying cardiac disease and one (0.02%) had tuberculosis. Among the six candidates in the post-exposure group who underwent further investigations in our institute, five (0.15%) were diagnosed to have tuberculosis. Although there was no statistically significant difference in tuberculosis detection between the groups (P = 0.051), there is a trend towards higher detection of tuberculosis in the post-exposure group.
In a country where the prevalence of tuberculosis is high, the pre-employment chest radiograph may still have a role in detecting tuberculosis in the post-exposure group.
胸部X光片在全球范围内被各类医疗保健机构以及其他政府和非政府机构用作就业和培训前的筛查工具。过去进行的许多研究表明，肺结核检测的阳性率相对较低，因此，作者对这种做法提出了质疑。
比较两组人群（即既往有医疗环境暴露史的人群（暴露后组）和无暴露史的人群（暴露前组））入院/入职前胸部X光片的价值，并确定两组之间在肺结核检测方面是否存在显著差异。
对2014年至2017年间我院所有报考本科和研究生课程的考生的胸部X光片报告进行回顾性分析。
记录检测到的各种异常情况，并比较两组的检查结果。
采用卡方检验比较两组比例。
暴露前组4333名考生中有30名（0.69%）胸部X光片显示肺实质、纵隔、心脏或胸膜有异常，暴露后组3379名考生中有53名（1.57%）有上述异常。在暴露前组中，6名（0.14%）被发现有潜在心脏病，1名（0.02%）患有肺结核。在我院接受进一步检查的暴露后组的6名考生中，5名（0.15%）被诊断为患有肺结核。虽然两组之间在肺结核检测方面无统计学显著差异（P = 0.051），但暴露后组有肺结核检测率更高趋势。
在一个肺结核患病率较高的国家，入职前胸部X光片在检测暴露后组的肺结核方面可能仍有作用。
