Tobin K, Klein J, Barbieri C, Heffner J E
University of Arizona Health Sciences Center, Department of Medicine, St. Joseph's Hospital and Medical Center, Phoenix 85001-2071, USA.
Am J Med. 1996 Oct;101(4):349-56. doi: 10.1016/S0002-9343(96)00228-8.
To determine the diagnostic yield of routine admission chest radiographs in patients with acute gastrointestinal (GI) hemorrhage and clinical predictors of radiographic abnormalities.
The study was a retrospective series of 202 adult patients with GI hemorrhage admitted to intensive care units at an academic medical center. Routine admission chest radiographs were obtained in 161 patients. These radiographs were reviewed by a study radiologist blinded to the study purpose. The radiologist scored radiographic abnormalities into categories of "minor" or "major," "new" or "previously known," and "with an intervention" or "without an intervention." Nominal logistic regression explored the data for clinical features that identified patients with major new radiographic abnormalities with or without an intervention.
Minor radiographic abnormalities were noted in 23 (14.3%) patients, of whom 17 (10.6%) patients had "new" (previously unknown) abnormalities. No minor abnormality prompted a therapeutic or diagnostic intervention. Major radiographic abnormalities were detected in 21 (13.0%) patients, of whom 19 (11.8%) had new findings. Major new findings prompted interventions in only 9 (5.6%) of patients. A history of lung disease and an abnormal lung physical examination predicted major new radiographic findings (P = 0.0001, sensitivity 79%, negative predictive value 96%). These variables also identified major new abnormalities that prompted interventions (P = 0.007, sensitivity 89%, negative predictive value 99%). Use of the logistic regression model to select patients for admission chest radiographs decreased charges from $1,068 to $580 for each detected major new radiographic abnormality and from $2,254 to $1,087 for major new radiographic abnormalities that prompted an intervention.
These data indicate that routine chest radiographs have a low yield in detecting major new radiographic abnormalities in patients with acute GI hemorrhage. Clinical criteria, available at the time of admission, may be useful for selecting patients for chest radiographic evaluations.
确定急性胃肠道（GI）出血患者常规入院胸部X线片的诊断率以及影像学异常的临床预测因素。
本研究为一项回顾性系列研究，纳入了202例入住某学术医学中心重症监护病房的成人GI出血患者。161例患者进行了常规入院胸部X线检查。这些X线片由一位对研究目的不知情的研究放射科医生进行阅片。放射科医生将影像学异常分为“轻微”或“严重”、“新发”或“既往已知”、“有干预措施”或“无干预措施”几类。名义逻辑回归分析探讨了用于识别有或无干预措施的严重新发影像学异常患者的临床特征数据。
23例（14.3%）患者存在轻微影像学异常，其中17例（10.6%）患者有“新发”（既往未知）异常。无轻微异常促使进行治疗或诊断性干预。21例（13.0%）患者检测到严重影像学异常，其中19例（11.8%）有新发发现。严重新发发现仅促使9例（5.6%）患者进行了干预。肺部疾病史和肺部体格检查异常可预测严重新发影像学发现（P = 0.0001，敏感性79%，阴性预测值96%）。这些变量还可识别出促使进行干预的严重新发异常（P = 0.007，敏感性89%，阴性预测值99%）。使用逻辑回归模型选择进行入院胸部X线检查的患者，每检测到一项严重新发影像学异常，费用从1068美元降至580美元，对于促使进行干预的严重新发影像学异常，费用从2254美元降至1087美元。
这些数据表明，常规胸部X线片在检测急性GI出血患者的严重新发影像学异常方面检出率较低。入院时可用的临床标准可能有助于选择进行胸部X线评估的患者。
