You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT ARCHIVES
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 130 No. 7, July 1995 TABLE OF CONTENTS
  Archives
  •  Online Features
  Original Articles
 This Article
 •References
 •Full text PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Citing articles on Web of Science (27)
 •Contact me when this article is cited
 Related Content
 •Similar articles in this journal
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit Add to Technorati Add to Twitter What's this?

Utility of Routine Chest Radiographs in the Surgical Intensive Care Unit

A Prospective Study

Yuman Fong, MD; Giles F. Whalen, MD; Robert J. Hariri, MD, PhD; Philip S. Barie, MD

Arch Surg. 1995;130(7):764-768.


Abstract

Objectives
To correlate patient condition and reasons for obtaining chest radiographs (CXRs) with the utility of CXRs in critical illness and to determine the potential impact of stricter criteria for obtaining a CXR in a surgical intensive care unit (ICU).

Design
Inception cohort study of 1003 CXRs examined prospectively.

Patients and Setting
A total of 157 consecutive patients admitted to the general surgical ICU of a 780-bed, urban, university-affiliated, tertiary care hospital.

Intervention
Nothing was done to influence the ordering of CXRs.

Outcome Measures
Influence of CXR findings on clinical management.

Results
The likelihood of a clinically important finding was 17% for CXRs obtained for no clear clinical indication (routine), 26% for those obtained to verify the position of a medical device, and 30% for those obtained for suspected clinical conditions. By univariate analysis, suspected pathophysiologic condition, admission APACHE II (Acute Physiology and Chronic Health Evaluation II) score, presence of a central venous or Swan-Ganz catheter, and length of ICU stay were all predictors of a significant finding. By multivariate analysis, the only independent predictor of a finding was a suspected clinical condition, and the only indwelling medical device that was an independent predictor of a finding was a Swan-Ganz catheter. If the criterion that routine CXRs should only be obtained in patients with Swan-Ganz catheters had been used, 200 CXRs would have been avoided during the 3-month study period. The only findings missed by not obtaining those CXRs would have been two malpositioned nasogastric tubes and one malpositioned central venous catheter.

Conclusions
Chest radiographs should only be obtained on surgical ICU patients for specific indications. Routine CXRs for ICU patients are justified only for patients with indwelling Swan-Ganz catheters. (Arch Surg. 1995;130:764-768)



Author Affiliations

From the Department of Surgery, Cornell University Medical College, New York, NY.



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

A Web-Based Delphi Study on the Indications of Chest Radiographs for Patients in ICUs
Hejblum et al.
Chest 2008;133:1107-1112.
ABSTRACT | FULL TEXT  

Low Value of Routine Chest Radiographs in a Mixed Medical-Surgical ICU
Hendrikse et al.
Chest 2007;132:823-828.
ABSTRACT | FULL TEXT  

Can We Abandon Daily Routine Chest Radiography in Intensive Care Patients?
Graat et al.
J Intensive Care Med 2005;20:238-246.
ABSTRACT  

Test-Ordering Strategy in the Intensive Care Unit
Krinsley
J Intensive Care Med 2003;18:330-339.
ABSTRACT  

Radiology in the Intensive Care Unit (Part I)
Trotman-Dickenson
J Intensive Care Med 2003;18:198-210.
ABSTRACT  

Routine Daily Chest Radiography in Patients with Pulmonary Artery Catheters
Houghton et al.
Am J Crit Care 2002;11:261-265.
ABSTRACT | FULL TEXT  

Routine Chest Radiographs in Pediatric Intensive Care Units
Quasney et al.
Pediatrics 2001;107:241-248.
ABSTRACT | FULL TEXT  

Postoperative portable chest radiographs: Optimum use in thoracic surgery
Graham et al.
J. Thorac. Cardiovasc. Surg. 1998;115:45-52.
ABSTRACT | FULL TEXT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1995 American Medical Association. All Rights Reserved.