Periodic chest radiography: unnecessary, expensive, but still pervasive.
Periodic chest radiography: unnecessary, expensive, but still pervasive.
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定期胸部X光检查：不必要、昂贵，但仍然普遍存在。
DOI：
10.1016/s0140-6736(98)10144-7
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
Reichman,LB
中科院分区：
文献类型：
--
作者：
Mangura,BT;Reichman,LB
在没有症状的人群中通过胸部X光检查进行VIEWPOINT筛查是没有用的（面板）。他们的结论是：“在没有临床症状的情况下，重复的胸部X线检查没有显示出临床价值或生产力，以证明其继续使用”。同样，卫生组织召集了一个放射科医生小组，研究放射照片的使用。他们的报告包括使用X光检查结核病。此外，不必要的X光片费用昂贵（占一个国家卫生支出的6-10%）。18世卫组织和FDA的建议得到了广泛支持，19-21疾病控制和预防中心（CDC）修订了其早期关于卫生保健工作者筛查的建议。[22] 1994年CDC的建议23指出，“无症状的PPD [结核菌素纯化蛋白衍生物]阴性HCW [卫生保健工作者]不需要进行常规胸部X线检查。PPD试验结果呈阳性的HCW应进行胸部X光检查，作为PPD试验初步评估的一部分;如果阴性，则不需要重复胸部X光检查，除非出现可能归因于TB的症状。对于结核菌素转换者和其他PPD阳性、结核病风险增加（例如医疗风险）的个人以及出现症状的卫生保健工作者，应立即进行检查，包括初次胸部X光片检查，并转诊接受确定性治疗或必要的异烟肼预防性治疗。23，24 1979年，如果美国所有医院都要对所有结核菌素阳性的员工进行X光检查，估计10总支出为8200575美元（每张胶片25美元）。这一估计是基于一个假设，即当时美国3280231名医院雇员中有10%是结核菌素反应者。1997年，美国有4 289 379名注册医院雇员; 25胸片的平均费用为80美元（UMDNJ大学医院放射科，纽瓦克，新泽西，美国）。假设10%的医院雇员是结核菌素反应者，10目前每年为这些保健工作者进行胸部X光检查的总费用约为3，400万美元。这一数字可能被低估，因为在某些地区，人口患结核病的风险可能更大。26在一项对美国8个州的10家私立医院进行的研究中，医院员工的结核病感染率为7- 21%。27. 21%的感染率显然会增加开支。医疗保健干预措施必须符合成本效益标准以及基于权威数据的科学合理性标准。常规定期胸部X线摄影随访，或作为结核病的筛查工具，不符合这些标准，不应继续。
VIEWPOINT screening by chest radiography in people without symptoms is of no use (panel). Their conclusion was:“In the absence of clinical symptoms, repeated chest radiographic examinations have not been shown to be of clinical value or productivity to justify their continued use”. Similarly, WHO convened a group of radiologists to study the use of radiographs. Their report included the use of radiographs for tuberculosis detection. Moreover, unnecessary radiographs were costly (6–10% of a country’s health expenditure). 18 WHO and FDA recommendations were widely supported, 19–21 and theCenters for Disease Control and Prevention (CDC) revised its earlier recommendations on screening of health-care workers. 22 The CDC recommendations of 199423 state that “routine chest radiographs are not required for asymptomatic, PPD [purified protein derivative of tuberculin] negative HCWs [health-care workers]. HCWs with positive PPD test results should have a chest radiograph as part of the initial evaluation of their PPD test; if negative, repeat chest radiographs are not needed unless symptoms develop that could be attributed to TB [tuberculosis]”. Health-care workers who are tuberculin converters and other PPD-positive individuals at increased risk (medical risks for example) of tuberculosis and those who develop symptoms should be promptly examined, including an initial chest radiograph, and referred for definitive treatment or isoniazid preventive therapy as indicated. 23, 24 In 1979, the estimated10 total expenditure was $8 200 575 (at $25.00 per film) if all hospitals in the USA were to take radiographs of all tuberculin-positive employees. The estimate was based on an assumption that 10% of the 3 280 231 hospital employees in the USA at that time were tuberculin reactors. In 1997, there were 4 289 379 registered hospital employees in the USA; 25 an average cost for a chest radiograph was $80.00 (Department of Radiology, UMDNJ-University Hospital, Newark, New Jersey, USA). On the basis of the assumption that 10% of hospital employees are tuberculin reactors, 10 the current total cost of annual chest radiographs for these health-care workers would be about $34 million. This figure may be an underestimate because in some areas the populations may have a greater risk of tuberculosis. 26 In one study of ten private hospitals in eight states in the USA, the rate of tuberculosis infection among hospital employees was 7–21%. 27 A 21% infection rate would obviously increase the expenditure. Health-care interventions have to meet criteria of costeffectiveness as well as scientific soundness based on authoritative data. Routine periodic chest radiography in follow-up, or as a screening tool for tuberculosis, does not meet these criteria and should not be continued.