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Published on: January 16, 2019
The value of routine chest radiographs in a paediatric intensive care unit: a prospective study
J W Valk1, F B Plötz, F A Schuerman
1Department of Radiology, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Insights
Paediatric intensive care unit (PICU) chest X-rays (CXRs) largely follow guidelines, but malpositioned devices and cardiopulmonary changes highlight their diagnostic value. Adjusting guidelines may improve CXR efficacy.
Area of Science:
- Radiology
- Paediatric Intensive Care
- Medical Imaging
Background:
- Chest X-ray films (CXRs) are routinely used in paediatric intensive care units (PICUs).
- Indications for CXRs include daily examinations and post-invasive procedure assessments.
Purpose of the Study:
- Evaluate the appropriateness of American College of Radiology (ACR) adult guidelines for paediatric patients.
- Assess the diagnostic efficacy of CXRs in the PICU setting.
Main Methods:
- Analyzed 174 CXRs from 74 paediatric patients.
- Compared CXR indications against ACR guidelines.
- Evaluated medical device positioning and noted cardiopulmonary changes.
Main Results:
- 67% of CXRs and 74% of no-CXR cases adhered to ACR guidelines.
- Malpositioned devices: 16% endotracheal tubes, 23% central venous lines, 15% nasogastric tubes.
- 63% of patients showed cardiopulmonary changes on CXRs.
Conclusions:
- Most PICU CXRs align with ACR guidelines.
- High rates of malpositioned devices and observed cardiopulmonary changes underscore CXR utility.
- Tailoring ACR guidelines for paediatric populations could reduce CXR frequency and enhance diagnostic value.
Background:
In many paediatric intensive care units (PI-CUs) chest X-ray films (CXRs) are required as part of the daily examination or after completion of invasive procedures.
Objective:
First, to evaluate if the American College of Radiology (ACR) guidelines for adult patients are appropriate for paediatric patients. Second, to assess the diagnostic efficacy of the CXRs.
Materials And Methods:
One-hundred-seventy-four CXRs acquired in 74 patients, either routinely or after invasive procedures, were analysed. The indication of the obtained CXRs, or the absence of indication in patients in whom no CXRs was taken, was compared with ACR guidelines. The position of medical devices was evaluated. Changes in cardiopulmonary status were noted.
Results:
Sixty-seven percent of the CXRs were in accordance with the ACR guidelines, and in 74% of patients in whom no CXRs were taken this was also in accordance with these guidelines. Sixteen percent of the endotracheal tubes, 23% of central venous lines and 15% of nasogastric tubes were malpositioned. Changes in cardiopulmonary status, after the initial film, were noted in 63%.
Conclusions:
The indications for the majority of CXRs in our PICU appeared to be in accordance with ACR guidelines. The high percentage of malpositioned tubes and lines and the number of cardiopulmonary changes on CXRs in a PICU underline the value of these films. Adjustments of the ACR guidelines for particular groups of paediatric patients may limit the number of CXRs taken and may further increase diagnostic efficacy.
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