UTILITY OF ROUTINE CHEST RADIOGRAPHS IN THE SURGICAL INTENSIVE-CARE UNIT - A PROSPECTIVE-STUDY

Objectives: To correlate patient condition and reasons for obtaining c hest radiographs (CXRs) with the utility of CXRs in critical illness a nd to determine the potential impact of stricter criteria for obtainin g a CXR in a surgical intensive care unit (ICU). Design inception coho rt study of 1003 CXRs examined prospectively. Patients aad Setting: A total of 157 consecutive patients admitted to the general surgical ICU of a 780-bed, urban, university-affiliated, tertiary care hospital. I ntervention: Nothing was done to influence the ordering of CXRs. Outco me Measures: Influence of CXR findings on clinical management. Results : The likelihood of a clinically important finding was 17% for CXRs ob tained for no clear clinical indication (routine), 26% for those obtai ned to verify the position of a medical device, and 30% for those obta ined for suspected clinical conditions. By univariate analysis, suspec ted 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 p redictor of a finding was a suspected clinical condition, and the only indwelling medical device that was an independent predictor of a find ing was a Swan-Ganz catheter. If the criterion that routine CXRs shoul d 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 c atheter. Conclusions: Chest radiographs should only be obtained on sur gical ICU patients for specific indications. Routine CXRs for ICU pati ents are justified only for patients with indwelling Swan-Ganz cathete rs.