Evaluation of the clinical utility of routine daily chest radiography in intensive care unit patients with tracheostomy tubes: A retrospective review

Jeffrey Cruz, Michael Ferra, Aditya Kasarabada, James Gasperino, Beth Zigmund

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

Background: The utilization of imaging procedures is under scrutiny due to high costs and radiation exposure to patients and staff associated with some radiologic procedures. Within our institution's intensive care unit (ICU), it is common for patients to undergo chest radiography (CR) not only immediately following tracheostomy tube placement but also on a daily basis, irrespective of the patient's clinical status. We hypothesize that the clinical utility of performing routine daily CR on patients with tracheostomy tubes is low and leads to unnecessary financial cost. Methods: A retrospective medical chart review was done on 761 CRs performed on 79 ICU patients with tracheostomy from April 2010 to July 2011. We searched the radiology reports of the 761 CRs for the presence of new radiographically detected complications and reviewed medical records to determine which complications were clinically suspected and which radiology reports led to changes in patient management. Results: Of the 761 CRs, only 18 (2.3%) radiographs revealed new complications. All complications were clinically suspected prior to imaging. Only 5 (0.7%) complications resulted in a management change. The most common management changes were a change in antibiotic regimen (0.3%) and ordering of diuretics (0.3%). Conclusions: Routine daily imaging of patients with tracheostomy in an ICU provides little clinical utility, and CR in this population should be performed selectively based on the patient's clinical status.

Original languageEnglish (US)
Pages (from-to)333-337
Number of pages5
JournalJournal of Intensive Care Medicine
Volume31
Issue number5
DOIs
StatePublished - Jan 1 2014

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Tracheostomy
Radiography
Intensive Care Units
Thorax
Radiology
Costs and Cost Analysis
Diuretics
Medical Records
Anti-Bacterial Agents
Population

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

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title = "Evaluation of the clinical utility of routine daily chest radiography in intensive care unit patients with tracheostomy tubes: A retrospective review",
abstract = "Background: The utilization of imaging procedures is under scrutiny due to high costs and radiation exposure to patients and staff associated with some radiologic procedures. Within our institution's intensive care unit (ICU), it is common for patients to undergo chest radiography (CR) not only immediately following tracheostomy tube placement but also on a daily basis, irrespective of the patient's clinical status. We hypothesize that the clinical utility of performing routine daily CR on patients with tracheostomy tubes is low and leads to unnecessary financial cost. Methods: A retrospective medical chart review was done on 761 CRs performed on 79 ICU patients with tracheostomy from April 2010 to July 2011. We searched the radiology reports of the 761 CRs for the presence of new radiographically detected complications and reviewed medical records to determine which complications were clinically suspected and which radiology reports led to changes in patient management. Results: Of the 761 CRs, only 18 (2.3{\%}) radiographs revealed new complications. All complications were clinically suspected prior to imaging. Only 5 (0.7{\%}) complications resulted in a management change. The most common management changes were a change in antibiotic regimen (0.3{\%}) and ordering of diuretics (0.3{\%}). Conclusions: Routine daily imaging of patients with tracheostomy in an ICU provides little clinical utility, and CR in this population should be performed selectively based on the patient's clinical status.",
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Evaluation of the clinical utility of routine daily chest radiography in intensive care unit patients with tracheostomy tubes : A retrospective review. / Cruz, Jeffrey; Ferra, Michael; Kasarabada, Aditya; Gasperino, James; Zigmund, Beth.

In: Journal of Intensive Care Medicine, Vol. 31, No. 5, 01.01.2014, p. 333-337.

Research output: Contribution to journalReview article

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T1 - Evaluation of the clinical utility of routine daily chest radiography in intensive care unit patients with tracheostomy tubes

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AU - Cruz, Jeffrey

AU - Ferra, Michael

AU - Kasarabada, Aditya

AU - Gasperino, James

AU - Zigmund, Beth

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N2 - Background: The utilization of imaging procedures is under scrutiny due to high costs and radiation exposure to patients and staff associated with some radiologic procedures. Within our institution's intensive care unit (ICU), it is common for patients to undergo chest radiography (CR) not only immediately following tracheostomy tube placement but also on a daily basis, irrespective of the patient's clinical status. We hypothesize that the clinical utility of performing routine daily CR on patients with tracheostomy tubes is low and leads to unnecessary financial cost. Methods: A retrospective medical chart review was done on 761 CRs performed on 79 ICU patients with tracheostomy from April 2010 to July 2011. We searched the radiology reports of the 761 CRs for the presence of new radiographically detected complications and reviewed medical records to determine which complications were clinically suspected and which radiology reports led to changes in patient management. Results: Of the 761 CRs, only 18 (2.3%) radiographs revealed new complications. All complications were clinically suspected prior to imaging. Only 5 (0.7%) complications resulted in a management change. The most common management changes were a change in antibiotic regimen (0.3%) and ordering of diuretics (0.3%). Conclusions: Routine daily imaging of patients with tracheostomy in an ICU provides little clinical utility, and CR in this population should be performed selectively based on the patient's clinical status.

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