On-demand chest radiographs for hypoxia: impact on clinical care

To determine the therapeutic yield of on-demand chest radiographs in intubated patients experiencing acute oxygen desaturation/hypoxia.

A retrospective study was conducted examining all intubated intensive care unit patients over a 2 ½-year period. Subjects were included only if the patient had undergone a comparison radiograph while intubated and if the word hypoxia or an equivalent alternative had been listed in the requisition. Radiographic findings were categorized into 3 groups: no change, minor new finding, or major new finding. A major new finding was defined as one that could result in a direct change in clinical management. Therapeutic yield was defined as any new clinical intervention documented in the electronic medical record occurring within the proximate timeframe after performing an on-demand radiograph. Interventions were recorded as appropriate or not appropriate to the expected therapy for each radiographic finding.

A total of 676 radiographic reports were studied. 55.3%, 20.4%, and 24.3% of the radiographic findings were categorized into no change, minor new finding, and major new finding groups. A major radiographic finding was more likely to have new interventions compared with a no-change radiograph [odds ratio, 6.44 (4.16-9.78)]. Most interventions were deemed appropriate for the radiographic findings.

On-demand radiographs performed for acute hypoxic clinical events yield a high percentage of major findings, with nearly half of them potentially influencing or resulting in new therapeutic interventions. Interventions were more likely in the major finding group, with most being appropriate. These results support the efficacy of the on-demand radiograph by providing evidence of its utility in patient management decisions.