Chest
Volume 132, Issue 3, September 2007, Pages 823-828
Journal home page for Chest

ORIGINAL RESEARCH
CRITICAL CARE MEDICINE
Low Value of Routine Chest Radiographs in a Mixed Medical-Surgical ICU

https://doi.org/10.1378/chest.07-1162Get rights and content

Objective

To determine the diagnostic efficacy (DE) and therapeutic efficacy (TE) of daily routine chest radiographs (CXRs), and to establish the impact of abandoning this CXR from daily practice on total CXR volume, ICU length of stay (LOS), readmission rate, and ICU mortality.

Design

Prospective controlled study in two parts. The first part comprised a 1-year period during which attending physicians were blinded for findings on daily routine CXRs and were only informed if something deemed important was seen by the radiologist (predefined major abnormalities) who reviewed all CXRs as usual. The second part comprised a half-year period during which daily routine CXRs were replaced by clinically indicated CXR.

Setting

Mixed medical-surgical ICU of a teaching hospital.

Results

Data on 1,780 daily routine CXRs in 559 hospital admissions were collected. DE of daily routine CXRs was 4.4%. The most frequent unexpected major abnormalities were new or progressive infiltrates (1.8%) and oropharyngeal tube malposition (0.7%). TE of daily routine CXRs was 1.9%. The most frequent intervention was oropharyngeal tube adjustment (0.6%). No relation was found for DE or TE and hospital admission type or intubation and mechanical ventilation. In the second study part, 433 CXRs were obtained in 274 admissions. Abandoning daily routine CXRs did not affect clinically indicated CXRs orders, or ICU LOS, readmission rate, and mortality. A total CXR volume reduction of 35% (which equaled $9,900 per bed per year [US dollars]) was observed after abandoning daily routine CXRs.

Conclusion

Diagnostic and therapeutic value of the daily routine CXR is low. Daily routine CXRs can be safely abandoned in the ICU.

Section snippets

Materials and Methods

We performed a prospective observational study evaluating the diagnostic and therapeutic value of all CXRs of patients admitted to the ICU during a period of 1 year. During this study period, we compared daily routine and clinically indicated CXRs in the same patient group. Thereafter, the daily routine regimen was abolished, all CXRs required a clinical indication, and data were collected for an additional half-year period (implementation phase).

The study was approved by the local ethical

Results

During the 1-year study period, 559 hospital admissions in 486 patients were evaluated. Demographics and clinical characteristics are summarized in Table 2. A total of 1,780 daily routine CXRs were evaluated. The median number of daily CXRs per patient per day was 1.0 (IQR, 0.88 to 1.16), including both daily routine CXRs (n = 1,780) and clinically indicated CXRs (n = 907). There were no differences when patients were stratified for ventilatory status (not intubated and not receiving mechanical

Discussion

This is the first blinded study evaluating the efficacy of daily routine CXRs in the ICU. The results confirm and corroborate previous data indicating that the diagnostic yield and therapeutic consequences of daily routine CXRs are very low. Furthermore, abolishing a daily routine CXR strategy did not affect ICU LOS, readmission rate, and hospital mortality

New and unsuspected clinically relevant abnormalities were found in only 4.4% of daily routine CXRs. Less than half of these induced a

References (16)

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Part of this study was presented at the Radiological Society of North America Meeting 2006 and the European Society of Intensive Care Medicine Meeting 2006.

All authors contributed substantially to this article and have no conflicts of interest to disclose.

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