title: Review of a large clinical series: the value of routinely obtained chest radiographs on admission to a mixed medical--surgical intensive care unit.
abstract: OBJECTIVE
  The efficacy of routinely obtained chest radiographs (CXRs) on admission to the intensive care unit (ICU) is largely unknown. The current study investigated the efficacy of routinely obtained admission CXRs and determined whether the value of this diagnostic test was dependent on patient category.
  
  
  METHODS
  Prospective nonrandomized controlled study. including 1081 admission CXRs of 1330 patients admitted to a 28-bed mixed medical-surgical university-affiliated ICU, over a 10-month period. To determine the value of admission CXRs, 2 categories of efficacy were used: diagnostic efficacy (the number of CXRs with a new or progressive major finding divided by the total number of CXRs) and therapeutic efficacy (the number of CXRs resulting in a change in clinical management divided by the total number of CXRs). Efficacy <15% was considered low. Patients were subclassified into subcategories on the basis of type of admission.
  
  
  RESULTS
  Of all admission CXRs, 227 were clinically indicated and 854 were routinely obtained to establish a baseline prior to admission to ICU. Diagnostic efficacy of routinely obtained admission CXRs was 11%. The majority of abnormalities were malposition of invasive devices and severe pulmonary congestion. Therapeutic efficacy of routinely obtained admission CXRs was only 5%. Subgroup analysis showed highest efficacy in nonsurgical patients.
  
  
  CONCLUSIONS
  In our mixed medical-surgical ICU the diagnostic and therapeutic efficacy of routinely obtained admission CXRs is low, though not completely negligible. Highest efficacy of CXRs was found in nonsurgical patients. Prospective studies are needed to determine whether abolishing this diagnostic test is a safe strategy.
authors.affiliation: Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. l.m.kager@amc.uva.nl
authors.forename: Liesbeth Martine
authors.initials: LM
authors.lastname: Kager
authors.forename: Anke
authors.initials: A
authors.lastname: Kröner
authors.forename: Jan M
authors.initials: JM
authors.lastname: Binnekade
authors.forename: Jan-Willem
authors.initials: JW
authors.lastname: Gratama
authors.forename: Peter E
authors.initials: PE
authors.lastname: Spronk
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.forename: Margreeth B
authors.initials: MB
authors.lastname: Vroom
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
mesh_terms: D003955:Diagnostic Tests, Routine; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008171:Lung Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008297:Male; D010343:Patient Admission; D011446:Prospective Studies; D013902:Radiography, Thoracic