Clinical effect of admission chest X-rays in Zimbabwe

The independent effect of admission chest X-rays on clinical management of 432 consecutive patients admitted to general medical wards was prospectively evaluated. Diagnosis, investigations, and treatment were recorded on the basis of clinical findings alone. A chest X-ray was then taken and clinical effect measured by the resultant changes. Although 226 (53%) admission chest X-rays were abnormal, only 9% changed management. In patients with no clinical evidence of cardiorespiratory disease ("routine" X-rays, n = 214) the clinical effect was slight; management was changed in 5% and patient benefit resulted in 1.4%. Clinical effect was greatest in patients (n = 172) with definite signs of new cardiorespiratory illness (altered management 14%, patient benefit 6%) and patients (n = 34) with "possible" chest disease (altered management 9%, patient benefit 9%). Omission of admission chest X-rays in patients with no clinical evidence of chest disease, those with clinically stable, known chest disease, and those with isolated cardiomegaly or hyperinflated lungs would result in a 60% reduction in the number of admission chest X-rays.