The utility of routine daily chest radiography in the surgical intensive care unit

Routine morning chest x-ray films (CXRs) are widely obtained in surgical intensive care unit (SICU) patients. During a 1-month time period we prospectively evaluated 525 routine morning CXRs in patients admitted to the SICU of a university trauma center (n = 256) or a suburban affiliate hospital (n = 269) to assess the impact of these CXRs on patient care. All CXRs were read by radiologists. Data on position of medical devices (CVP lines, endotracheal tubes, etc.) and cardiopulmonary (CP) findings were collected. A total of 1028 medical devices were evaluated. Fifty-five (5.4%) were considered to be in a minor incorrect position that did not adversely affect patient care and only 13 (1.3%) devices required repositioning for patient care or safety. Seventy-eight CXRs were read as normal. There were 775 CP findings on the remaining 477 CXRs. When compared with previous CXRs, only 12% (89 of 775) of the findings were considered new, 65% were unchanged, 14% were improved, and 15% demonstrated worsening of a known finding. Of the 89 new CP findings, only three had any potential clinical impact (pneumothorax in two, effusion in one). These data demonstrate an extremely low yield of clinically significant and unsuspected new CP findings or device malposition on the routine morning CXR. We conclude that routine daily chest radiography should be abandoned and that the need for a morning CXR should be based on clinical necessity.