The effect of chest radiographs on the management and clinical course of patients with acute cough

Abstract

The authors studied 2018 consecutive patients with a cough of less than 1 month's duration, presenting for medical care with this problem for the first time. Chest films were taken of all of the last 1819 of these patients. After physicians had specified diagnoses and patient management plans for the last 1531 of these 1819 patients, 98 per cent of the 1531 were randomized either to a group whose chest films were then used in their care, or to a group whose chest films were not available to the physician. The results show that chest radiographs ordered by physicians resulted in potentially beneficial change in the care of only 3 per cent of patients. Only use of chest radiographs not ordered by physicians led to the appropriate addition of antibiotics to the care of patients with infiltrates, and probably to improved illness outcome. Criteria for efficient, effective use of chest radiographs in the management of patients with acute cough are needed.