Efficacy of chest radiography in pediatric intensive care

We prospectively evaluated the efficacy and clinical usefulness of bedside chest radiography in a pediatric intensive-care unit. Seven hundred ninety-five radiographs were evaluated in 126 patients over a 10-week period. Eighty-one percent of all radiographs showed one or more cardiopulmonary abnormalities, and 25% of routine radiographs had findings that altered management of patients. Nineteen percent of radiographs, including 17% of routine radiographs, showed a malpositioned tube or catheter. Thirty-five percent of endotracheal tubes shown on postintubation radiographs and 41% of central venous catheters shown on post-catheter placement radiographs were malpositioned. Forty-five percent of radiographs with a previous reading showed a significant interval change. Radiographs in patients 1 year old or younger showed more cardiopulmonary abnormalities (p less than .04), tube or catheter malpositions (p less than .03), and significant interval changes (p less than .03), and they elicited more changes in clinical management (p less than .01) than did radiographs in patients over 1 year old. The frequency of management changes dictated by radiographs increased with increasing amounts of respiratory support (p less than .01). Our data indicate that bedside radiography in the pediatric intensive-care setting has a high efficacy and clinical utility.