Abstract
Purpose
Chestx-ray (CXR) is the most frequently ordered radiological test in Canada. Despite published guidelines, variable policies exist amongst different hospitals for ordering of preoperative CXRs. The purpose of this study was to systematically review the literature on the value of screening CXRs and establish evidence to support guidelines for the use of preoperative screening CXRs.
Source
Medline and Embase were searched under set terms for all English language articles published during 1966–2004. All eligible studies were reviewed and data were extracted individually by two authors. Of the 513 articles identified, 14 studies met both inclusion and exclusion criteria.
Principal findings
The quality of published evidence was modest as only six of the studies were rated as fair and eight as poor. Of the reported studies, diagnostic yield increased with age. However, most of the abnormalities consisted of chronic disorders such as cardiomegaly and chronic obstructive pulmonary disease (up to 65%). The rate of subsequent investigations was highly variable (4–47%). When further investigations were performed, the proportion of patients who had a change in management was low (10% of investigated patients). Postoperative pulmonary complications were also similar between patients who had preoperative CXRs (12.8%) and patients who did not (16%).
Conclusion
An association between preoperative screening CXRs and decrease in morbidity or mortality could not be established. As the prevalence of CXR abnormalities is low in patients under the age of 70, there is fair evidence that routine CXRs should not be performed for patients in this age group without risk factors. For patients over 70, there is insufficient evidence for or against performance of routine CXRs. The current recommendation from the Guidelines Association Committee that routine CXRs should not be performed for patients over 70 without risk factors is supported by this study.
Résumé
Objectif
La radiographie pulmonaire (RXP) est le test radiologique le plus demandé au Canada. Malgré les directives publiées, différentes politiques de demande de RXP préopératoires existent dans les hôpitaux. Nous voulions faire une revue systématique des documents sur la valeur des RXP de dépistage préopératoire et établir une preuve appuyant les directives sur leur usage.
Source
Nous avons passé en revue les bases Medline et Embase sous des termes déterminés pour tous les articles en anglais publiés de 1966 à 2004. Toutes les études admissibles ont été revues et les données extraites isolément par deux auteurs. Des 513 articles retenus, 14 études répondaient aux critères d’inclusion et d’exclusion.
Constatations principales
La qualité de la preuve publiée était modeste, car seulement six études ont été cotées acceptables et huit pauvres. Dans ces études, le rendement diagnostique augmentait avec l’âge. Cependant, la majorité des anomalies étaient des troubles chroniques comme la cardiomégalie et la maladie pulmonaire obstructive chronique (jusqu’à 65 %). Le taux d’examens subséquents était très variable (4–47 %). Quand d’autres tests étaient effectués, une faible proportion (10 % des patients testés) de patients voyaient leur traitement modifié. Les complications pulmonaires postopératoires étaient aussi similaires chez les patients qui avaient eu (12,8 %) ou non (16 %) des RXP préopératoires.
Conclusion
Une association entre les RXP de dépistage préopératoire et une baisse de la morbidité ou de la mortalité n’a pas pu être établie. Comme la prévalence des anomalies détectées lors des RXP était faible chez les patients de moins de 70 ans, il semble évident que des RXP de routine ne devraient pas être réalisés pour les patients de ce groupe d’âge sans facteurs de risque. Pour les patients de plus de 70 ans, la preuve est insuffisante pour décider s’il y a lieu de procéder à des RXP de routine. La recommandation actuelle du Comité des directives de l’Association voulant que les RXP de routine ne soient pas réalisés pour les patients de plus de 70 ans sans facteurs de risque est soutenue par notre étude.
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Joo, H.S., Wong, J., Naik, V.N. et al. The value of screening preoperative chest x-rays: a systematic review. Can J Anesth 52, 568–574 (2005). https://doi.org/10.1007/BF03015764
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DOI: https://doi.org/10.1007/BF03015764