The clinical value of daily routine chest radiographs in a mixed medical-surgical intensive care unit is low

• Published in: Critical care (London, England) Vol. 10; no. 1; p. R11
• Main Authors: Graat, Marleen E, Choi, Goda, Wolthuis, Esther K, Korevaar, Johanna C, Spronk, Peter E, Stoker, Jaap, Vroom, Margreeth B, Schultz, Marcus J
• Format: Journal Article
• Language: English
• Published: England National Library of Medicine - MEDLINE Abstracts 01-02-2006; BioMed Central Ltd; BioMed Central
• Subjects: Adult; Aged; APACHE; Diagnostic Tests, Routine - statistics & numerical data; Female; Hospitals, University; Humans; Intensive Care Units; Male; Middle Aged; Netherlands; Radiography, Thoracic - statistics & numerical data; Reproducibility of Results; Sensitivity and Specificity; Netherlands
• DOI: 10.1186/cc3955
• EISSN: 1466-609X; 1364-8535
• ISSN: 1364-8535

The clinical value of daily routine chest radiographs (CXRs) in critically ill patients is unknown. We conducted this study to evaluate how frequently unexpected predefined major abnormalities are identified with daily routine CXRs, and how often these findings lead to a change in care for intensive care unit (ICU) patients.
This was a prospective observational study conducted in a 28-bed, mixed medical-surgical ICU of a university hospital.
Over a 5-month period, 2,457 daily routine CXRs were done in 754 consecutive ICU patients. The majority of these CXRs did not reveal any new predefined major finding. In only 5.8% of daily routine CXRs (14.3% of patients) was one or more new and unexpected abnormality encountered, including large atelectases (24 times in 20 patients), large infiltrates (23 in 22), severe pulmonary congestion (29 in 25), severe pleural effusion (13 in 13), pneumothorax/pneumomediastinum (14 in 13), and malposition of the orotracheal tube (32 in 26). Fewer than half of the CXRs with a new and unexpected finding were ultimately clinically relevant; in only 2.2% of all daily routine CXRs (6.4% of patients) did these radiologic abnormalities result in a change to therapy. Subgroup analysis revealed no differences between medical and surgical patients with regard to the incidence of new and unexpected findings on daily routine CXRs and the effect of new and unexpected CXR findings on daily care.
In the ICU, daily routine CXRs seldom reveal unexpected, clinically relevant abnormalities, and they rarely prompt action. We propose that this diagnostic examination be abandoned in ICU patients.