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

Abstract：

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 strategy.

journal_name

J Intensive Care Med

journal_title

Journal of intensive care medicine

authors

Kager LM,Kröner A,Binnekade JM,Gratama JW,Spronk PE,Stoker J,Vroom MB,Schultz MJ

doi

10.1177/0885066610366925

subject

Has Abstract

pub_date

2010-07-01 00:00:00

pages

227-32

issue

eissn

0885-0666

issn

1525-1489

pii

0885066610366925

journal_volume

pub_type

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