Research

The clinical value of daily routine chest radiographs in a mixed medical–surgical intensive care unit is low

Marleen E Graat¹ , Goda Choi^1,2, Esther K Wolthuis^1,3, Johanna C Korevaar⁴, Peter E Spronk⁵, Jaap Stoker⁶, Margreeth B Vroom¹ and Marcus J Schultz^1,7,8

¹Medical student, Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

²Resident, Departments of Intensive Care Medicine and Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

³Resident, Departments of Intensive Care Medicine and Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

⁴Clinical Epidemiologist, Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

⁵Internist-intensivist, Department of Intensive Care Medicine, Gelre Hospital (Location Lukas), Apeldoorn, The Netherlands

⁶Radiologist, Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

⁷Anaesthsiologist-intensivist, Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

⁸Internist-intensivist, Research Coordinator, Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

author email corresponding author email

Critical Care 2006, 10:R11doi:10.1186/cc3955

Published:	30 December 2005

Abstract

Introduction

The clinical value of daily routine chest radiographs (CXRs) in critically ill patients is unknown. We conducted this study to evaluate how frequently unexpected predefined major abnormalities are identified with daily routine CXRs, and how often these findings lead to a change in care for intensive care unit (ICU) patients.

Method

This was a prospective observational study conducted in a 28-bed, mixed medical–surgical ICU of a university hospital.

Results

Over a 5-month period, 2,457 daily routine CXRs were done in 754 consecutive ICU patients. The majority of these CXRs did not reveal any new predefined major finding. In only 5.8% of daily routine CXRs (14.3% of patients) was one or more new and unexpected abnormality encountered, including large atelectases (24 times in 20 patients), large infiltrates (23 in 22), severe pulmonary congestion (29 in 25), severe pleural effusion (13 in 13), pneumothorax/pneumomediastinum (14 in 13), and malposition of the orotracheal tube (32 in 26). Fewer than half of the CXRs with a new and unexpected finding were ultimately clinically relevant; in only 2.2% of all daily routine CXRs (6.4% of patients) did these radiologic abnormalities result in a change to therapy. Subgroup analysis revealed no differences between medical and surgical patients with regard to the incidence of new and unexpected findings on daily routine CXRs and the effect of new and unexpected CXR findings on daily care.

Conclusion

In the ICU, daily routine CXRs seldom reveal unexpected, clinically relevant abnormalities, and they rarely prompt action. We propose that this diagnostic examination be abandoned in ICU patients.