An Audit of Routine Chest X-ray Done During Pre-employment Medical Screening in South-Western Nigeria

Abstract

Routine pre-employment chest radiography is one of the examinations performed to assess the medical fitness of prospective employees in many establishments around the world. It is also used to ensure that prospective employees can perform their jobs safely without placing co-workers and others at potential health risk by ruling out the existence of chronic infectious pulmonary diseases like tuberculosis. Despite these focused goals, there are concerns over poor positive result yield, associated unnecessary exposure to ionizing radiation and wastage of economic resources linked to pre-employment chest xray. This study aimed to audit the reports of pre-employment chest radiographs, documented associated radiological findings and subsequently examined the clinical relevance or otherwise of this practice in the locality under study. The records of 725 patients, who had underwent pre-employment chest x-rays between January 2014 and December 2016 in three foremost teaching hospitals in South-western Nigeria, were retrospectively reviewed. All findings were documented including abnormalities 'flagged' as clinically-significant by the radiologists' reports irrespective of the severity or the effect of the abnormality on the employment outcome of the individual. The results show that majority of the patients referred for preemployment chest x-ray presented with normal radiological findings (n = 687, 94.8%). The significant abnormal findings (n = 38, 5.2%) were chronic cardiovascular disorder (n = 15, 2.0%), followed by chronic lung disease (n = 18, 2.5%) and finally skeletal abnormality (n = 5, 0.7%). Individuals 25 years and below presented with no abnormal findings while abnormal findings are found in subjects in the age range of 26-30 years and above. This audit has shown that chest radiography has little or no clinical relevance in routine pre-employment medical screening of physically healthy and asymptomatic prospective employees. Therefore, chest radiography should be restricted to individuals with clinical findings suggestive of cardio-thoracic disorders during pre-employment medical screening.

Interest of Systematic Chest Radiography during Periodic Medical Visits in Workers

“…Some abnormalities on chest X-ray were found in the context of chest pain, dyspnea and fever. For this reason, most authors recommend that chest X-rays should be performed on a case-by-case basis after a clinical examination including a thorough anamnesis and in particular a good interrogation on the known occupational and environmental exposures [3]- [10].…”