Chest
ORIGINAL RESEARCHCRITICAL CARE MEDICINELow Value of Routine Chest Radiographs in a Mixed Medical-Surgical 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
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Cited by (79)
REDUCE – Indication catalogue based ordering of chest radiographs in intensive care units
2022, Journal of Critical CareThe Value of Supine Chest X-Ray in the Diagnosis of Pneumonia in the Basal Lung Zones
2018, Academic RadiologySingle intervention for a reduction in portable chest radiography (pCXR) in cardiovascular and surgical/trauma ICUs and associated outcomes
2018, Journal of Critical CareCitation Excerpt :It is unknown if these same results can be achieved in routine clinical practice among any ICU population without at the same time mandating provider ordering behavior through the terms of a clinical trial or changes in order structure. All previously observed studies of pCXR reduction in the ICU have managed provider behavior, through clinical trials, deliberate changes to ordering structure, and often by requiring a clinical indication for obtaining a radiograph [5,13-15]. To date, there are no studies that have evaluated the efficacy, durability or adverse events after a single time point intervention.
Bedside lung ultrasound in the care of the critically ill
2017, Critical Care and ResuscitationClinical relevance of the routine daily chest X-Ray in the surgical intensive care unit
2017, American Journal of SurgeryCitation Excerpt :Overall, we found no differences in outcomes, including mortality, complications, LOS or requirement for mechanical ventilation. These findings are in line with multiple other studies including the largest meta-analysis performed on this topic.1–3,9,10,13–16,19 This meta-analysis analyzed 9 studies with a combined total of 39,358 CXRs for 9611 patients and found no difference in ICU or hospital mortality, ICU or overall LOS or duration of mechanical ventilation.10
High-value care in the surgical intensive care unit: Effect on ancillary resources
2016, Journal of Surgical Research
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.