The clinical value of daily routine chest radiographs in a mixed medical–surgical intensive care unit is low

This was a prospective observational study conducted in a 28-bed, mixed medical–surgical ICU of a university hospital.Over a 5-month period, 2,457 daily routine CXRs were done in 754 consecutive ICU patients. The majority of these CXRs did not reveal any new predefined major finding. In only 5.8% of daily routine CXRs (14.3% of patients) was one or more new and unexpected abnormality encountered, including large atelectases (24 times in 20 patients), large infiltrates (23 in 22), severe pulmonary congestion (29 in 25), severe pleural effusion (13 in 13), pneumothorax/pneumomediastinum (14 in 13), and malposition of the orotracheal tube (32 in 26). Fewer than half of the CXRs with a new and unexpected finding were ultimately clinically relevant; in only 2.2% of all daily routine CXRs (6.4% of patients) did these radiologic abnormalities result in a change to therapy. Subgroup analysis revealed no differences between medical and surgical patients with regard to the incidence of new and unexpected findings on daily routine CXRs and the effect of new and unexpected CXR findings on daily care.In the ICU, daily routine CXRs seldom reveal unexpected, clinically relevant abnormalities, and they rarely prompt action. We propose that this diagnostic examination be abandoned in ICU patients.Chest radiographs (CXRs) are frequently obtained in intensive care units (ICUs) [1]. They can be obtained routinely, on a daily basis (so-called 'daily routine CXRs'); such radiographs are generally ordered without any specific reason. Another strategy is to order CXRs only if clinically indicated (so-called 'on demand CXRs'); these radiographs are usually obtained following a change in clinical status or supportive devices.The consensus opinion of the American College of Radiology Expert Panel is that daily routine CXRs are indicated in patients with acute cardiopulmonary problems and in patients receiving mechanical ventilation [2]. In practice, this includes the majority of ICU patients.