Utility of routine chest radiographs in a medical-surgical intensive care unit: a quality assurance survey

Objective To determine the utility of routine chest radiographs (CXRs) in clinical decision-making in the intensive care unit (ICU). Design A prospective evaluation of CXRs performed in the ICU for a period of 6 months. A questionnaire was completed for each CXR performed, addressing the indication for the radiograph, whether it changed the patient's management, and how it did so. Setting A 14-bed medical-surgical ICU in a university-affiliated, tertiary care hospital. Patients A total of 645 CXRs were analyzed in 97 medical patients and 205 CXRs were analyzed in 101 surgical patients. Results Of the 645 CXRs performed in the medical patients, 127 (19.7%) led to one or more management changes. In the 66 surgical patients with an ICU stay <48 hours, 15.4% of routine CXRs changed management. In 35 surgical patients with an ICU stay <greater than or equal to>48 hours, 26% of the 100 routine films changed management. In both the medical and surgical patients, the majority of changes were related to an adjustment of a medical device. Conclusions Routine CXRs have some value in guiding management decisions in the ICU. Daily CXRs may not, however, be necessary for all patients.