Radiology: Daily chest radiography in the ICU offers no added benefit

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Systematic but unselective daily routine chest radiography can likely be eliminated without increasing adverse outcomes in adult patients in intensive care units (ICUs), found a meta-analysis published in the May issue of Radiology

Researchers from the division of pulmonary and critical care medicine at the University of Missouri-Columbia utilized their study to identify a subgroup of patients in which a daily routine chest radiography may be beneficial, as well as systematically examining whether abandoning daily routine chest radiography would create adverse outcomes, including mortality and increased length of stay.

“Obtaining a daily routine chest radiograph for every ICU patient remains a common practice despite the accumulating evidence suggesting that this may not be necessary,” wrote the authors. They noted that this practice, in addition to recommendations of the American College of Radiology (ACR), is based on study findings from the 1980’s and 1990’s which suggested that a high incidence of new or unexpected findings may be seen through the employment of daily routine chest radiographs. Recent studies however, have reported a lower incidence of unexpected radiographic abnormalities that have led to a change in treatment practices for this patient population, the researchers explained.

Yuji Oba, MD, lead author of this meta-analysis, and colleagues narrowed their research to eight relevant studies via MEDLINE, Cochrane Database, Database of Abstracts of Reviews of Effects, Biological Abstracts and CINAHL searches, that observed the effect of moving away from daily routine chest radiography in adults in ICUs in a total of 7,078 patients.

Of the 7,078 included patients, 3,429 underwent chest radiography (daily routine) and 3,649 underwent only clinically indicated chest radiography (on-demand). According to a pooled analysis, the elimination of daily routine chest radiography was determined as having no effect on either hospital or ICU mortality.

In addition, the authors found no significant increase in hospital length of stay and/or days spent on ventilators between the on-demand and daily routine groups.

Moreover, the analyses failed to identify any subgroup in which performing daily routine chest radiography would possibly be beneficial, wrote Oba and colleagues. “Performing chest radiography for a specific indication rather than on a routine basis may reduce workload, radiation exposure to patients and healthcare personnel, and healthcare costs,” they said.

While further studies are warranted in order to identify a specific patient population that would benefit from daily routine chest radiographs, the authors concluded, “We assert that daily routine chest radiography can potentially be safely eliminated in most ICU patients.”