Comparison of clinical outcomes from chest X-rays of smokers and non-smokers in a general practice population.

The chest X-ray (CXR) is a quick and inexpensive radiological exam with judicious use of CXRs being a valuable tool in patient care, while unnecessary use increasing costs, adding to patient radiation exposure, and may be in conflict with standards of patient care 1 . Under EU Directive from 1997 on radiation protection, doctors are advised that there should be justification for every requested for X-ray examination 2 . This may be interpreted as the results of the examination (either a positive or negative result) which will lead to a change in patient management. A study was carried out in general practice which retrospectively examined the number of CXRs ordered in a general practice population over a 10 year period, and how the results impacted on clinical management. A total of 7181 patient records were reviewed, and from this a cohort of 655 patients were identified that had at least 1 CXR performed in the 10 year period. Outcomes were collapsed into two dichotomous variables, management in general practice and management in hospital. We found that the majority of CXR reports did not result in a change in clinical management (84.1% in current or prior smokers and 81.1% in non-smokers). Patients with a current or prior smoking history were referred more frequently for CXR than their non-smoking counterparts, however we found no difference between patients with a current or previous smoking history versus non-smokers in relation to CXR results necessitating referral to hospital for further management (X2=0.19, df=1, p=0.66).