Chest
Volume 88, Issue 5, November 1985, Pages 691-696
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Clinical Investigations
Efficacy of Chest Radiography in a Respiratory Intensive Care Unit: A Prospective Study

https://doi.org/10.1378/chest.88.5.691Get rights and content

A prospective study of chest radiographic examinations in a respiratory intensive care unit was conducted to determine the diagnostic and therapeutic efficacy of such examinations. Analysis of data from 1,354 x-ray films from 167 patients revealed a 34.5 percent incidence of new (or increased) abnormalities, or tube or catheter malposition. Changes in diagnostic approach or therapeutic measures, excluding catheter position adjustments, occurred after 28.5 percent of the examinations. Radiographic yield was higher when a change in clinical condition prompted the radiographic examination than when the examination was a routine morning study. Changes in the approach to patient management were also more likely (42.7 percent) following examinations that were prompted by a change in a patient's clinical status. Less than 6 percent of the radiographic films taken post-procedure demonstrated abnormalities potentially related to the procedure. We conclude that, in a respiratory intensive care unit: 1) routine morning radiographic examination frequently demonstrates unexpected or changing abnormalities, many of which prompt changes in diagnosis or management; 2) radiographic evaluation of a change in a patient's clinical condition has a higher yield than routine examinations; and 3) post-procedure radiographic examination uncommonly demonstrates complications related to the procedure, but frequently demonstrates abnormalities of tube or catheter placement.

Section snippets

Materials and Methods

The Intermountain Respiratory Intensive Care Unit (IRICU) at LDS Hospital is a three-bed primary and referral facility staffed with onsite residents and pulmonary fellows and oncall pulmonary intensivists. The IRICU is designed to treat patients in whom the primary threat to life is respiratory or ventilatory failure. The most frequent clinical problems encountered in this setting include adult respiratory distress syndrome, pneumonia, pulmonary embolism, chronic obstructive pulmonary disease

Results

Thirteen-hundred and fifty-four technically adequate chest radiographic films of 167 patients were analyzed from November, 1980 to January, 1983. One-hundred and twenty-two (9 percent) were repeated because they were judged to be technically inadequate for interpretation due to motion, improper exposure, or inadequate patient positioning. All those repeated were judged to be adequate for interpretation. One-hundred and twenty-five others were deleted from the data base due to incomplete data

Discussion

The use of routine screening chest radiography for detection of lung cancer10, tuberculosis11, or other cardiopulmonary diseases12 has been demonstrated to be of little use in asymptomatic individuals. Similarly, routine radiographic chest examination was found to have a low yield of abnormalities in patients without suspected chest diseases1, as well as in young patients with acute chest complaints but no hemoptysis or abnormality on physical examination2. The increasing cost of medical care

ACKNOWLEDGMENTS

The authors thank the nursing staff of the Intermountain Respiratory Intensive Care Unit and the pulmonary fellows of the University of Utah. We also thank Jerri Duncan-Goff for assistance in preparation of the manuscript.

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Dr. Bekemeyer was a research fellow of the American Lung Association at the time these studies were done.

Presented in part at the 50th Annual Scientific Assembly, American College of Chest Physicians, Dallas, October 8-12, 1984.

Manuscript received December 14; revision accepted May 7.

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