The clinical value of daily routine chest radiographs in a mixed medical–surgical intensive care unit is low

Journal article

Ventilator-associated pneumonia is one of the critical complications identified by a chest x-ray (CXR). However, there is a controversy about the use of CXRs. Overuse of the CXR has also identified concern among the ICU patient population. The purpose of this evidenced-based practice project was to determine if there were differences in patient outcomes when receiving daily routine CXRs as compared to clinically-indicated CXRs. Patient outcomes measured were: ICU length of stay, complications while on the ventilator and ICU mortality, number of ventilator days, diagnostic efficacy, therapeutic efficacy, costs, and radiation exposure The author identified 30 articles in the search process. These articles were reduced to 15 after identifying duplicates and applying the inclusion and exclusion criteria. Analysis was performed using an evidence table according to the process developed by Melynk and Fineout-Overholt. Analysis of the research findings from 15 studies that included randomized clinical trials, observational studies, cohort study, cluster randomized crossover study, meta-analysis, blind-peer reviews, and expert opinions revealed moderate support for the use of clinically-indicated CXRs for patients in the ICU on a ventilator. Following the analysis of the literature a -retrospective chart audit was performed to determine if practice patterns in my institution matched the recommendations in the literature. A sample of 60 patient records was drawn from 234 records of patients who were admitted to the medical ICU between June 1, 2014 and August 31, 2014. The sample was equally divided between men and women who were primarily Caucasian with a mean age of 59.3. The most common admitting diagnoses were: ventilator dependent respiratory failure, sepsis, and chronic obstructive pulmonary disease. Patient outcomes were measured using a researcher developed chart audit tool. Analysis of the chart audit data revealed that in a three month period only one patient was treated with the clinically-indicated CXR regimen. The recommendation is that the professional practice group should begin discussion regarding the development of a policy and procedure in order to differentiate between patients who need daily routine versus clinically-indicated CXRs for improved outcomes and adherence to the current evidence

Authors: Graat, ME; Choi, G; Wolthuis, EK; Korevaar, JC; Spronk, PE

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BioMed Central
• Journal: Critical Care
• Volume: 10
• Issue: 1
• Pages: R11-R11
• Publication date: 2005-12-30
• DOI: 10.1186/cc3955
• EISSN: 1466-609X
• ISSN: 1364-8535
• Language: English
• Keywords: Emergency medicine; Incidence (geometry); Observational study; Intensive care unit; Pediatrics; Pleural effusion; Radiography; Surgery; Medicine; Pneumothorax; Intensive care medicine; Chest radiograph; Internal medicine