Utility of routine chest radiographs in a medical-surgical intensive care unit: a quality assurance survey

Objective To determine the utility of routine chest radiographs (CXRs) in c linical decision-making in the intensive care unit (ICU). Design A prospective evaluation of CXRs performed in the ICU for a period o f 6 months. A questionnaire was completed for each CXR performed, addressin g the indication for the radiograph, whether it changed the patient's manag ement, and how it did so. Setting A 14-bed medical-surgical ICU in a university-affiliated, tertiary care hospital. Patients A total of 645 CXRs were analyzed in 97 medical patients and 205 C XRs were analyzed in 101 surgical patients. Results Of the 645 CXRs performed in the medical patients, 127 (19.7%) led to one or more management changes. In the 66 surgical patients with an ICU stay <48 hours, 15.4% of routine CXRs changed management. In 35 surgical pa tients with an ICU stay <greater than or equal to>48 hours, 26% of the 100 routine films changed management. In both the medical and surgical patients , the majority of changes were related to an adjustment of a medical device . Conclusions Routine CXRs have some value in guiding management decisions in the ICU. Daily CXRs may not, however, be necessary for all patients.