title: The value of routine chest radiographs in a paediatric intensive care unit: a prospective study.
abstract: BACKGROUND
  In many paediatric intensive care units (PI-CUs) chest X-ray films (CXRs) are required as part of the daily examination or after completion of invasive procedures.
  
  
  OBJECTIVE
  First, to evaluate if the American College of Radiology (ACR) guidelines for adult patients are appropriate for paediatric patients. Second, to assess the diagnostic efficacy of the CXRs.
  
  
  METHODS
  One-hundred-seventy-four CXRs acquired in 74 patients, either routinely or after invasive procedures, were analysed. The indication of the obtained CXRs, or the absence of indication in patients in whom no CXRs was taken, was compared with ACR guidelines. The position of medical devices was evaluated. Changes in cardiopulmonary status were noted.
  
  
  RESULTS
  Sixty-seven percent of the CXRs were in accordance with the ACR guidelines, and in 74% of patients in whom no CXRs were taken this was also in accordance with these guidelines. Sixteen percent of the endotracheal tubes, 23% of central venous lines and 15% of nasogastric tubes were malpositioned. Changes in cardiopulmonary status, after the initial film, were noted in 63%.
  
  
  CONCLUSIONS
  The indications for the majority of CXRs in our PICU appeared to be in accordance with ACR guidelines. The high percentage of malpositioned tubes and lines and the number of cardiopulmonary changes on CXRs in a PICU underline the value of these films. Adjustments of the ACR guidelines for particular groups of paediatric patients may limit the number of CXRs taken and may further increase diagnostic efficacy.
authors.affiliation: Department of Radiology, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: Valk
authors.forename: F B
authors.initials: FB
authors.lastname: Plötz
authors.forename: F A
authors.initials: FA
authors.lastname: Schuerman
authors.forename: H
authors.initials: H
authors.lastname: van Vught
authors.forename: P P
authors.initials: PP
authors.lastname: Kramer
authors.forename: E J
authors.initials: EJ
authors.lastname: Beek
mesh_terms: D002675:Child, Preschool; D003422:Critical Care / Q000379:methods; D004864:Equipment and Supplies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards; D011446:Prospective Studies; D013902:Radiography, Thoracic