The Impact of Computed Tomography of the Chest on the Management of Patients in a Medical Intensive Care Unit

Purpose: To understand whether chest computed tomographies (CTs) have utility in a medical intensive care unit (MICU) population as previously noted in nonmedical critically ill patients. Patients and Methods: We conducted a retrospective cohort study of patients receiving chest CTs in the MICU at an urban, academic institution. Indications for, findings on, and care changes made after chest CT were obtained. We identified patient characteristics associated with having a care change clearly related to the CT using multivariate regression. Results: We evaluated 134 patients; 64 (47.8%) had a chest CT with intravenous contrast. Common findings included pulmonary consolidation (46.3%), nonconsolidative pulmonary parenchymal disease (29.1%), and pleural effusion (35.1%). Of the chest CTs, 23.9% were followed by changes in management clearly related to the study. Use of intravenous contrast was associated with increased odds of having a care change (adjusted odds ratio [95% confidence interval [CI] versus noncontrast study: 3.14 [1.18-8.37], P = .022) and having the CT performed 1 or 2 days after ICU admission versus on the day of ICU admission was associated with lower odds of a care change (odds ratio [95% CI]: 0.29 [0.09-0.99], P = .048). Conclusion: Less than one-quarter of chest CTs in the MICU result in management. Intravenous contrast-enhanced CTs and CTs done on the day of ICU admission have increased odds of utility.