title: Evaluation of the Clinical Utility of Routine Daily Chest Radiography in Intensive Care Unit Patients With Tracheostomy Tubes: A Retrospective Review.
abstract: BACKGROUND
  The utilization of imaging procedures is under scrutiny due to high costs and radiation exposure to patients and staff associated with some radiologic procedures. Within our institution's intensive care unit (ICU), it is common for patients to undergo chest radiography (CR) not only immediately following tracheostomy tube placement but also on a daily basis, irrespective of the patient's clinical status. We hypothesize that the clinical utility of performing routine daily CR on patients with tracheostomy tubes is low and leads to unnecessary financial cost.
  
  
  METHODS
  A retrospective medical chart review was done on 761 CRs performed on 79 ICU patients with tracheostomy from April 2010 to July 2011. We searched the radiology reports of the 761 CRs for the presence of new radiographically detected complications and reviewed medical records to determine which complications were clinically suspected and which radiology reports led to changes in patient management.
  
  
  RESULTS
  Of the 761 CRs, only 18 (2.3%) radiographs revealed new complications. All complications were clinically suspected prior to imaging. Only 5 (0.7%) complications resulted in a management change. The most common management changes were a change in antibiotic regimen (0.3%) and ordering of diuretics (0.3%).
  
  
  CONCLUSIONS
  Routine daily imaging of patients with tracheostomy in an ICU provides little clinical utility, and CR in this population should be performed selectively based on the patient's clinical status.
authors.affiliation: Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cruz
authors.affiliation: Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Ferra
authors.affiliation: Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Aditya
authors.initials: A
authors.lastname: Kasarabada
authors.affiliation: Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Gasperino
authors.affiliation: Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA Department of Radiologic Sciences, Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA, USA. beth.zigmund@tenethealth.com.
authors.forename: Beth
authors.initials: B
authors.lastname: Zigmund
mesh_terms: D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics; D016638:Critical Illness / Q000191:economics / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D011182:Postoperative Care; D000069079:Radiation Exposure; D013902:Radiography, Thoracic / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014139:Tracheostomy; D019564:Unnecessary Procedures / Q000191:economics
keywords: imaging utilization; intensive care unit; portable chest x-ray; tracheostomy tube