Canadian Journal of Anaesthesia

, Volume 40, Issue 11, pp 1022–1027 | Cite as

Value of routine preoperative chest x-rays: a meta-analysis

  • Chantai Archer
  • Adrian R. Levy
  • Maurice McGregor
Reports of Investigation

Abstract

The purpose of this study was to estimate the frequency with which routine postoperative chest x-rays lead to clinically relevant new information. All articles in English, French and Spanish relating to routine chest radiography in North American or European populations were reviewed, using the Medline database and references listed in reviews and periodicals published from 1966 to 1992, inclusive. Twenty-one reports which supplied sufficient information were included for meta-analysis. On average, abnormalities were found in 10% of routine preoperative chest films. In only 1.3% of films were the abnormalities unexpected, i.e., were not already known or would not otherwise have been detected (95% CI: 0 to 2.8%). These findings were of sufficient importance to cause modification of management in only 0.1% (95% CI: 0 to 0.6%). The frequency with which the new information influenced health could not be estimated. Assuming only the direct cost to the health care system of each radiograph ($23), each finding which influenced management in any way would cost $23,000. It is concluded that in North American or European populations when a reliable history and a clinical examination are carried out, the cost of this test is so high in relation to the clinical information provided that it is no longer justifiable.

Key words

Anaesthesia: pre-anaesthetic assessment, chest x-ray 

Résumé

Cette étude vise à évaluer la fréquence des anomalies cliniques significatives découvertes par la radiologie préopératoire systématique. Tous les articles en anglais, en français et en espagnol traitant du sujet en Amérique du Nord et en Europe ont été révisés à l’aide de la banque de données de Medline et des bibliographies de périodiques et de revues publiés de 1966 à 1992. Les 21 rapports fournissant, suffisamment d’informations sont inclus dans la méta-analyse. En moyenne, des anomalies se retrouvent sur 10% des radiographies préopératoires. Sur seulement 1,3% des films, les anomalies sont inattendues, c’està-dire qu’elles n’étaient déjà pas connues ou n’auraient pu être décelées autrement (IC 95%: 0 à 2,8%). Ces nouvelles données auraient pu en elles-mêmes modifier la ligne de conduite adoptée dans 0,1% des cas (IC 95%: 0 à 0,6%). La fréquence avec laquelle ces trouvailles ont influencé la santé ne peut être évaluée. En attribuant au système sanitaire le seul coût direct de chaque radiographie (23$), toute trouvaille susceptible de modifier la ligne de conduite coûte 23,000$. On en conclut que pour les populations nord-américaines et européennes, en présence d’une anamnèse et d’un examen clinique fiables, les renseignements obtenus ne justifient pas le coût de l’examen.

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Copyright information

© Canadian Anaesthesiologists 1993

Authors and Affiliations

  • Chantai Archer
    • 1
  • Adrian R. Levy
    • 1
    • 2
  • Maurice McGregor
    • 1
    • 2
  1. 1.Conseil d’évaluation des technologies de la santé du QuébecMontréal
  2. 2.Royal Victoria Hospital and McGill UniversityMontreal

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