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Routine chest radiographs in pediatric intensive care units
M W Quasney1, D M Goodman, M Billow
1Department of Pediatrics, Crippled Children's Foundation Research Center, Le Bonheur Children's Medical Center, University of Tennessee, Memphis, Tennessee 38103, USA. mquasney@utmem.edu
Insights
Routine portable chest x-rays (CXRs) in the pediatric intensive care unit (PICU) led to interventions in 45% of cases. Interventions were more frequent in smaller children with devices and active cardiopulmonary issues.
Area of Science:
- Pediatric critical care medicine
- Diagnostic imaging
- Radiology
Background:
- Routine portable morning chest x-rays (CXRs) are common in pediatric intensive care units (PICUs).
- The utility and impact of these routine CXRs on patient management remain areas for investigation.
Purpose of the Study:
- To assess the frequency of interventions based on routine morning CXRs in PICU patients.
- To identify specific pediatric patient subgroups that benefit most from routine CXRs.
Main Methods:
- A prospective, multi-institutional study involving 15 tertiary care hospitals.
- Data collected included patient weight, diagnosis, presence of cardiopulmonary problems, devices, and length of stay.
- Interventions performed based on CXR interpretation were recorded.
Main Results:
- Of 512 routine CXRs, 45% resulted in at least one intervention.
- Interventions were more common in smaller children (
- The frequency of interventions increased with the number of devices (50% with ≥2 devices) and presence of active cardiopulmonary problems (51%).
Conclusions:
- Routine CXRs are valuable in guiding interventions for critically ill pediatric patients.
- Smaller children, those with multiple devices, and patients with active cardiopulmonary issues are more likely to have interventions based on routine CXRs.
Objectives:
To determine whether interventions were performed based on portable routine morning chest x-rays (CXRs) in pediatric intensive care unit (PICU) patients and to identify patient subgroups for whom the routine CXR is most useful.
Design:
Prospective multiinstitutional study. Setting. PICUs of 15 tertiary care hospitals. Patients. PICU patients who received a routine morning CXR were included in the study.
Outcome Measures:
Recorded data included: weight, diagnosis, presence of active cardiopulmonary problems, length of stay, and number and type of devices. The number and types of interventions based on the interpretation of the CXR were recorded.
Results:
Five hundred twelve routine CXRs were evaluated. The majority of the routine chest radiographs were obtained on patients who were admitted for cardiovascular disease (195/512; 38%) or respiratory failure (186/512; 36%), and 465/512 of the routine CXRs (91%) were performed on patients with one or more devices. Two hundred thirty-one of the 512 routine CXRs (45%) resulted in 1 or more interventions. One hundred fifty-five of the 284 routine CXRs (55%) obtained in children /=40 kg, respectively. The frequency of interventions increased from 19% in children with no devices to >50% in children with 2 or more devices. One or more interventions were performed in 27% of routine CXRs when no active cardiopulmonary problems were present, compared with 51% of routine CXRs when active cardiopulmonary problems were present. Diagnosis and length of intensive care unit stay at the time the routine CXR was obtained did not affect the percentage of CXRs that resulted in interventions.
Conclusions:
Routine CXRs are more likely to result in interventions in the smaller, critically ill child with one or more devices and if active cardiopulmonary problems are present.
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