The utility of routine emergency department chest radiography in a population at high risk for tuberculosis

The purpose of this study was to determine the utility of performing routine screening chest radiography on all asymptomatic admissions from the emergency department in an urban population at high risk for contracting tuberculosis (TB). Chest radiographs were obtained on all asymptomatic patients admitted through the emergency department for drug detoxification or psychiatric illness at two urban hospitals in an area endemic for multidrug-resistant TB. The chest radiographs were interpreted prospectively by one of two radiologists, and the results were correlated with age, sex, and clinical outcome. A total of 481 chest radiographs were evaluated (407 men, 74 women; average age, 38 years). Of these, 436 (91%) were negative. Of the 45 with abnormalities, 35 (7%) were chronic, requiring no further work-up, whereas 10 (2%) had changes considered of immediate consequence. Of those with acute abnormalities, five patients presented with nodular densities, ranging from 5 mm to 3 cm in diameter; two patients had lobar infiltrates; and subsegmental atelectasis, congestive changes and an abnormal aortic contour were noted on one examination each. Of the six patients not lost to follow-up, five improved with medical therapy, and one was scheduled for surgical excision. The individuals with radiographic findings were significantly older than those with negative chest radiographs (47 years vs. 37 years). Only one patient had active TB; three others had chronic calcified granulomas. We conclude that routine chest radiography in young, asymptomatic individuals considered at high risk for contracting TB rarely detects significant pulmonary abnormalities or evidence of active TB.