Do we need daily CXR?
In most ICUs, there is a practice of doing chest x-ray daily on every patient. But do we need it ?
In a recent study, value of daily CXR looked into, to determine its diagnostic efficacy (DE) and therapeutic efficacy (TE), and to establish its impact on ICU length of stay (LOS), readmission rate and ICU mortality.
Design: Prospective controlled study in two parts.
The first part: comprised a 1-year period during which attending physicians were blinded for findings on daily routine CXRs and were only informed if something deemed important was seen by the radiologist (predefined major abnormalities) who reviewed all CXRs as usual.
The second part: comprised a half-year period during which daily routine CXRs were replaced by clinically indicated CXR.
Setting: Mixed medical-surgical ICU of a teaching hospital.
Results: Data on 1,780 daily routine CXRs in 559 hospital admissions were collected.
- The most frequent unexpected major abnormalities were new or progressive infiltrates (1.8%)
- Oropharyngeal tube malposition (0.7%)
- Abandoning daily routine CXRs did not affect clinically indicated CXRs orders, or ICU LOS, readmission rate, and mortality.
A total CXR volume reduction of 35% (which equaled $9,900 per bed per year [US dollars]) was observed after abandoning daily routine CXRs.
Conclusion: Diagnostic and therapeutic value of the daily routine CXR is low. Daily routine CXRs can be safely abandoned in the ICU.
Related previous pearl: Is confirmatory chest-x-ray always necessary?
Reference: click to get abstract
Low Value of Routine Chest Radiographs in a Mixed Medical-Surgical ICU - Chest. 2007; 132:823-828
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