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 CareCitation Excerpt :Taken into account radiation exposure to patients and medical technical staff and patient handling with the risk for the transmittance of (nosocomial) infections as well as secondary injuries for both patients and medical staff, a restrictive approach seems reasonable [15-18]. Additionally, CXR examinations on ICU are a costly human resource intensive strategy and a more selective approach might substantially reduce healthcare costs [4,19,20]. Further, point-of-care ultrasound is now widely available on ICU wards and gained importance in recent years for various evaluations traditionally assessed with CXRs [21-25].
The Value of Supine Chest X-Ray in the Diagnosis of Pneumonia in the Basal Lung Zones
2018, Academic RadiologyBedside 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 :Future studies should not focus on the diagnostic value of the PDCXR, as this has already been shown to be higher than ADCXR in multiple studies. Rather, the next step is to examine the clinical and physical exam findings and objective data which should trigger the ordering of a CXR, in order to optimize their diagnostic value.1–3,5,16,17,21 Our study is limited in that we did not evaluate for the clinical indications that led physicians to order CXRs.
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.