Hubbell F A, Greenfield S, Tyler J L, Chetty K, Wyle F A
N Engl J Med. 1985 Jan 24;312(4):209-13. doi: 10.1056/NEJM198501243120404.
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.
我们评估了入院时拍摄的常规胸部X光片对加利福尼亚州长滩退伍军人管理局医疗中心内科病房患者治疗的影响——该人群已知心肺疾病患病率很高。前瞻性地确定了开具胸部X光片的原因，三名医学系教员查阅了入院患者的病历，以确定胸部X光片结果对患者护理的影响。在研究的491名患者中，有294名（60%）被开具了常规胸部X光片。在这294名患者中，有106名（36%）被发现有异常。其中86名患者的检查结果为已知的、慢性的且稳定；只有20名患者的检查结果是新发现的。只有12名（4%）患者的治疗因胸部X光片结果而改变。在这些患者中，只有一名患者如果没有拍摄胸部X光片，可能会遗漏适当的治疗，但所采取的治疗并未改善该患者的预后。我们得出结论，即使在心肺疾病患病率很高的人群中，常规入院胸部X光片对患者护理的影响也非常小。我们建议不要仅仅因为患者入院就开具此类X光片。
