title: Clinical relevance of the routine daily chest X-Ray in the surgical intensive care unit.
abstract: BACKGROUND
  A daily Chest X-ray (CXR) is obtained in many surgical intensive care units (SICU). This study implemented a selective CXR protocol in a high volume, academic SICU and evaluated its impact on clinical outcomes.
  
  
  METHODS
  All SICU patients admitted in 2/2010 were compared with patients admitted in 2/2012. Between the time periods, a protocol eliminating the routine daily CXRs was instituted.
  
  
  RESULTS
  In 02/2010 and 02/2012, 107 and 90 patients were admitted to the SICU, respectively, for a total of 1384 patient days. CXRs decreased from 365 (57.1% of patient-days) in 2010 to 299 (40.9% of patient days; p < 0.001) in 2012. A greater proportion of Physician Directed CXRs (PDCXRs) had new findings (80.8%) compared to Automatic Daily CXRs (ADCXRs) (23.5%, p < 0.001). There was no difference in overall or SICU length of stay, ventilator-free days, morbidity or mortality.
  
  
  CONCLUSIONS
  Eliminating ADCXRs decreased the number of CXRs performed, without affecting LOS, mechanical ventilation, morbidity or mortality. Physician-directed ordering of CXRs increased the diagnostic value of the CXR and decreased the number of clinically irrelevant CXRs performed.
authors: University of Southern California, Keck School of Medicine, Department of Surgery, Division of Acute Care Surgery, Los Angeles County General Hospital (LAC+USC), Los Angeles, CA, USA. Electronic address: shelby.resnick@uphs.upenn.edu.
authors: Shelby
authors: S
authors: Resnick
authors: University of Southern California, Keck School of Medicine, Department of Surgery, Division of Acute Care Surgery, Los Angeles County General Hospital (LAC+USC), Los Angeles, CA, USA. Electronic address: kenji.inaba@med.usc.edu.
authors: Kenji
authors: K
authors: Inaba
authors: University of Southern California, Keck School of Medicine, Department of Surgery, Division of Acute Care Surgery, Los Angeles County General Hospital (LAC+USC), Los Angeles, CA, USA. Electronic address: ef.karamanos@gmail.com.
authors: Efstathios
authors: E
authors: Karamanos
authors: University of Southern California, Keck School of Medicine, Department of Surgery, Division of Acute Care Surgery, Los Angeles County General Hospital (LAC+USC), Los Angeles, CA, USA. Electronic address: dimitra.skiada@gmail.com.
authors: Dimitra
authors: D
authors: Skiada
authors: University of Southern California, Keck School of Medicine, Department of Surgery, Division of Acute Care Surgery, Los Angeles County General Hospital (LAC+USC), Los Angeles, CA, USA. Electronic address: dollahit@med.usc.edu.
authors: James A
authors: JA
authors: Dollahite
authors: University of Southern California, Keck School of Medicine, Department of Surgery, Division of Acute Care Surgery, Los Angeles County General Hospital (LAC+USC), Los Angeles, CA, USA. Electronic address: obi.okoye@hotmail.com.
authors: Obi
authors: O
authors: Okoye
authors: University of Southern California, Keck School of Medicine, Department of Surgery, Division of Acute Care Surgery, Los Angeles County General Hospital (LAC+USC), Los Angeles, CA, USA. Electronic address: peep.talving@usc.edu.
authors: Peep
authors: P
authors: Talving
authors: University of Southern California, Keck School of Medicine, Department of Surgery, Division of Acute Care Surgery, Los Angeles County General Hospital (LAC+USC), Los Angeles, CA, USA. Electronic address: demetria@usc.edu.
authors: Demetrios
authors: D
authors: Demetriades
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D012121:Respiration, Artificial; D019564:Unnecessary Procedures; D055815:Young Adult
keywords: CXR; ICU; Resource utilization