The impact of routine chest radiography on ICU management decisions: an observational study

OBJECTIVE: To document the impact of routine daily chest radiographs on treatment decisions in a medical ICU. METHODS: The study sample consisted of 200 consecutive patients in an 11-bed medical ICU of a university-affiliated teaching hospital. During the study period, each patient's current and previous chest radiographs were reviewed in the ICU during morning rounds. A computerized digital video display system was used. Changes in therapy made as a consequence of this review were recorded. RESULTS: A total of 471 chest radiographs were reviewed. The patients' mean score on the Acute Physiology and Chronic Health Evaluation II (APACHE II) was 14.6 +/- 2.5, and the mean length of stay in the ICU was 3.6 days +/- 2.1 days (range, 11-24 days). A change in therapy was made on the basis of information obtained from review of the chest radiograph in 174 instances (37% of radiographs). The most frequent therapeutic interventions were use of a loop diuretic to treat pulmonary edema (26%), repositioning of an endotracheal tube (24%), and diagnostic studies to determine the cause of a new pulmonary infiltrate (16%). At least one change in therapy was made for 91 (66%) of the 138 intubated patients but for only 14 (23%) of the 62 nonintubated patients; this difference was significant. Differences among diagnostic groups were largely a reflection of the number of patients who were intubated. CONCLUSION: Routine daily chest radiographs may be justified in critically ill patients in a medical ICU because for a large proportion of these patients management decisions are made on the basis of information obtained from the chest radiograph. This observation may be applicable only to ICUs that have a high turnover of patients who are in the unit for a short time.

This article has been cited by other articles:

				G. Hejblum, V. Ioos, J.-F. Vibert, P.-Y. Boelle, L. Chalumeau-Lemoine, C. Chouaid, A.-J. Valleron, and B. Guidet A Web-Based Delphi Study on the Indications of Chest Radiographs for Patients in ICUs Chest, May 1, 2008; 133(5): 1107 - 1112. [Abstract] [Full Text] [PDF]

				K. A. Hendrikse, J. W. C. Gratama, W. ten Hove, J. H. Rommes, M. J. Schultz, and P. E. Spronk Low Value of Routine Chest Radiographs in a Mixed Medical-Surgical ICU Chest, September 1, 2007; 132(3): 823 - 828. [Abstract] [Full Text] [PDF]

				D. L. HOBBS Chest Radiography for Radiologic Technologists Radiol. Technol., July 1, 2007; 78(6): 494 - 516. [Abstract] [Full Text] [PDF]

				M. E. Graat, J. Stoker, M. B. Vroom, and M. J. Schultz Can We Abandon Daily Routine Chest Radiography in Intensive Care Patients? J Intensive Care Med, July 1, 2005; 20(4): 238 - 246. [Abstract] [PDF]

				M. J. Schultz, M. L. Janower, R. M. Schwartzstein, and M. Krivopal Daily Routine Chest Radiographs Chest, March 1, 2004; 125(3): 1167 - 1167. [Full Text] [PDF]

				J. S. Krinsley Test-Ordering Strategy in the Intensive Care Unit J Intensive Care Med, November 1, 2003; 18(6): 330 - 339. [Abstract] [PDF]

				A. G. Duarte Radiographic Assessment of Intravascular Volume Chest, December 1, 2002; 122(6): 1879 - 1881. [Full Text] [PDF]

				G. S. Martin, E. W. Ely, F. E. Carroll, and G. R. Bernard Findings on the Portable Chest Radiograph Correlate With Fluid Balance in Critically Ill Patients Chest, December 1, 2002; 122(6): 2087 - 2095. [Abstract] [Full Text] [PDF]