Routine chest radiographs in pediatric intensive care units

Objectives. To determine whether interventions were performed based on port able routine morning chest x-rays (CXRs) in pediatric intensive care unit ( PICU) patients and to identify patient subgroups for whom the routine CXR i s most useful. Design. Prospective multiinstitutional study. Setting. PICUs of 15 tertiary care hospitals. Patients. PICU patients who received a routine morning CXR were included in the study. Outcome Measures. Recorded data included: weight, diagnosis, presence of ac tive cardiopulmonary problems, length of stay, and number and type of devic es. The number and types of interventions based on the interpretation of th e CXR were recorded. Results. Five hundred twelve routine CXRs were evaluated. The majority of t he routine chest radiographs were obtained on patients who were admitted fo r cardiovascular disease (195/512; 38%) or respiratory failure (186/512; 36 %), and 465/512 of the routine CXRs (91%) were performed on patients with o ne or more devices. Two hundred thirty-one of the 512 routine CXRs (45%) re sulted in 1 or more interventions. One hundred fifty-five of the 284 routin e CXRs (55%) obtained in children less than or equal to 10 kg resulted in o ne or more interventions, compared with 61/152 (40%) and 15/76 (20%) of rou tine CXRs obtained in children 10 to 40 kg and greater than or equal to 40 kg, respectively. The frequency of interventions increased from 19% in chil dren with no devices to >50% in children with 2 or more devices. One or mor e interventions were performed in 27% of routine CXRs when no active cardio pulmonary problems were present, compared with 51% of routine CXRs when act ive cardiopulmonary problems were present. Diagnosis and length of intensiv e care unit stay at the time the routine CXR was obtained did not affect th e percentage of CXRs that resulted in interventions. Conclusions. Routine CXRs are more likely to result in interventions in the smaller, critically ill child with one or more devices and if active cardi opulmonary problems are present.