UTILITY OF ROUTINE ADMISSION CHEST RADIOGRAPHS IN PATIENTS WITH ACUTEGASTROINTESTINAL HEMORRHAGE ADMITTED TO AN INTENSIVE-CARE UNIT

PURPOSE: To determine the diagnostic yield of routine admission chest radiographs in patients with acute gastrointestinal (GI) hemorrhage an d clinical predictors of radiographic abnormalities. PATIENTS AND METH ODS: The study was a retrospective series of 202 adult patients with G I hemorrhage admitted to intensive care units at an academic medical c enter. Routine admission chest radiographs were obtained in 161 patien ts. These radiographs were reviewed by a study radiologist blinded to the study purpose. The radiologist scored radiographic abnormalities i nto categories of ''minor'' or ''major,'' ''new'' or ''previously know n,'' and ''with an intervention'' or ''without an intervention.'' Nomi nal logistic regression explored the data for clinical features that i dentified patients with major new radiographic abnormalities with or w ithout an intervention. RESULTS: Minor radiographic abnormalities were noted in 23 (14.3%) patients, of whom 17 (10.6%) patients had ''new'' (previously unknown) abnormalities. No minor abnormality prompted a t herapeutic or diagnostic intervention. Major radiographic abnormalitie s were detected in 21 (13.0%) patients, of whom 19 (11.8%) had new fin dings. Major new findings prompted interventions in only 9 (5.6%) of p atients. A history of lung disease and an abnormal lung physical exami nation predicted major new radiographic findings (P = 0.0001, sensitiv ity 79%, negative predictive value 96%). These variables also identifi ed major new abnormalities that prompted interventions (P = 0.007, sen sitivity 89%, negative predictive value 99%). Use of the logistic regr ession model to select patients for admission chest radiographs decrea sed charges from $1,068 to $580 for each detected major new radiograph ic abnormality and from $2,254 to $1,087 for major new radiographic ab normalities that prompted an intervention. CONCLUSION: These data indi cate that routine chest radiographs have a low yield in detecting majo r new radiographic abnormalities in patients with acute GI hemorrhage. Clinical criteria, available at the time of admission, may be useful for selecting patients for chest radiographic evaluations.