The impact of routine chest radiography on ICU management decisions: an observational study.
OBJECTIVE
To document the impact of routine daily chest radiographs on treatment decisions in a medical ICU.


METHODS
The study sample consisted of 200 consecutive patients in an 11-bed medical ICU of a university-affiliated teaching hospital. During the study period, each patient's current and previous chest radiographs were reviewed in the ICU during morning rounds. A computerized digital video display system was used. Changes in therapy made as a consequence of this review were recorded.


RESULTS
A total of 471 chest radiographs were reviewed. The patients' mean score on the Acute Physiology and Chronic Health Evaluation II (APACHE II) was 14.6 +/- 2.5, and the mean length of stay in the ICU was 3.6 days +/- 2.1 days (range, 11-24 days). A change in therapy was made on the basis of information obtained from review of the chest radiograph in 174 instances (37% of radiographs). The most frequent therapeutic interventions were use of a loop diuretic to treat pulmonary edema (26%), repositioning of an endotracheal tube (24%), and diagnostic studies to determine the cause of a new pulmonary infiltrate (16%). At least one change in therapy was made for 91 (66%) of the 138 intubated patients but for only 14 (23%) of the 62 nonintubated patients; this difference was significant. Differences among diagnostic groups were largely a reflection of the number of patients who were intubated.


CONCLUSIONS
Routine daily chest radiographs may be justified in critically ill patients in a medical ICU because for a large proportion of these patients management decisions are made on the basis of information obtained from the chest radiograph. This observation may be applicable only to ICUs that have a high turnover of patients who are in the unit for a short time.
Marik
P E
PE
Department of Critical Care Medicine, St Vincent Hospital, Worcester, MA, USA.
Janower
M L
ML
D018806:APACHE; D016638:Critical Illness; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007442:Intubation, Intratracheal; D008404:Massachusetts; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D012140:Respiratory Tract Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D012494:Sampling Studies; D014600:Utilization Review