The Impact of Routine Admission Chest X-Ray Films on Patient Care

To the Editor: Hubbell et al., in the January 24 issue of the Journal , report that "routine" admission chest x-ray films in only 4 of 294 patients without acute cardiorespiratory findings produced data that could affect therapy. 1 We suggest that admission chest x-ray films in elderly patients with mental-status and behavioral changes be classified as "diagnostic" rather than "routine." Sir William Osler noted, "In old age, pneumonia may be latent, coming on without a chill; the cough and expectoration are slight... the physical signs [are] ill-defined and changeable." 2 Murphy and Fine reported on 29 patients, age 60 or older, . . . No extract is available for articles shorter than 400 words.