Ym. Fong et al., UTILITY OF ROUTINE CHEST RADIOGRAPHS IN THE SURGICAL INTENSIVE-CARE UNIT - A PROSPECTIVE-STUDY, Archives of surgery, 130(7), 1995, pp. 764-768
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.