On-demand rather than daily-routine chest radiography prescription may change neither the number nor the impact of chest computed tomograpby and ultrasound studies in a multidisciplinary intensive care unit

Background: Elimination of daily-routine chest radiographs (CXRs) may influence chest computed tomography (CT) and ultrasound practice in critically ill patients. Methods: This was a retrospective cohort study including all patients admitted to a university-affiliated intensive care unit during two consecutive periods of 5 months, one before and one after elimination of daily-routine CXR. Chest CT and ultrasound studies were identified retrospectively by using the radiology department information system. indications for and the diagnostic/dierapeutic yield of chest CT and ultrasound studies were collected. Results: Elimination of daily-routine CXR resulted in a decrease of CXRs per patient day from 1.1 +/- 0.3 to 0.6 +/- 0.4 (P <0.05). Elimination did not affect duration of stay or mortality rates. Neither the number of chest CT studies nor the ratio of chest CT studies per patient day changed with the intervention: Before elimination of daily-routine CXR, 52 chest CT studies were obtained from 747 patients; after elimination, 54 CT studies were obtained from 743 patients. Similarly, chest ultrasound practice was not affected by the change of CXR strategy: Before and after elimination, 21 and 27 chest ultrasound studies were performed, respectively. Also, timing of chest CT and ultrasound studies was not different between the two study periods. During the two periods, 40 of 106 chest CT studies (38%) and 18 of 48 chest ultra- sound studies (38%) resulted in a change in therapy. The combined therapeutic yield of chest CT and ultrasound studies did not change with elimination of daily-routine CXR. Conclusions: Elimination of daily-routine CXRs may not affect chest CT and ultrasound practice in a multidisciplinary intensive care uni

The clinical value of routinely obtained postoperative chest radiographs in post-anaesthesia care unit patients seems poor-a prospective observational study

Background: The clinical value of routinely obtained postoperative chest radiographs (CXRs) in post-anaesthesia care unit (PACU) patients is largely unknown. Methods: To determine the diagnostic efficacy and treatment impact of postoperative routinely obtained CXRs in a university hospital PACU. Observational study collecting the expectations of attending physicians, the findings on routinely obtained CXRs and actions based on the findings on these CXRs in postoperative PACU patients. A 22-bed PACU in a university hospital in the Netherlands. Patients admitted to the PACU during a 9-month period. The analysis was restricted to CXRs routinely obtained during the first PACU admission, i.e., CXRs obtained during later admissions were excluded. Diagnostic efficacy, defined as the percentage of CXRs showing any unexpected major abnormality; treatment impact, defined as the percentage of CXRs showing an unexpected major abnormality that triggered a predefined change in therapy. Results: The analysis included 294 postoperative CXRs. Of them 94 showed a new and unexpected predefined major abnormality (diagnostic efficacy of 35%). Of these 94 CXRs, only 10 triggered an intervention (treatment impact of 4%). Conclusions: The diagnostic efficacy of routinely obtained postoperative CXRs in PACU patients is fair; the treatment impact seems low if we assume that all CXRs that showed an abnormality but were not followed by an intervention and did not require an intervention. Future research should focus on the safety and cost-effectiveness of abrogating routine postoperative CXRs

Review of a large clinical series: the value of routinely obtained chest radiographs on admission to a mixed medical--surgical intensive care unit

BACKGROUND AND OBJECTIVES: 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. MATERIALS AND 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 strateg