Utility of routine chest radiographs in the surgical intensive care unit. A prospective study

Y. Fong, G. F. Whalen, R. J. Hariri and P. S. Barie
Department of Surgery, Cornell University Medical College, New York, NY, USA.

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.

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