PEDIATRICS Vol. 83 No. 4 April 1989, pp. 465-470
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Routine Chest Radiographs in Pediatric Intensive Care: A Prospective Study

Gabriel J. Hauser MD1, Murray M. Pollack MD1, Carlos J. Sivit MD1, George A. Taylor MD1, Dorothy I. Bulas MD1, and Christopher J. Guion MD1

1 The Departments of Critical Care Medicine and Radiology, Children's Hospital National Medical Center, and the Departments of Anesthesiology, Radiology, and Child Health and Development, George Washington University School of Medicine and Health Science, Washington, DC

The clinical value of routine chest radiographs was prospectively evaluated in a pediatric intensive care unit. Physicians were asked to predict findings of clinical impact in 353 routine morning chest radiographs performed in 101 patients after examining the patients. In 81 instances (23%), the clinical impact of the chest radiographs was incorrectly predicted and significant alterations in management would have potentially been missed had the chest radiographs not been available. These 81 chest radiographs included 72 unpredicted radiographic changes of clinical significance, and nine chest radiographs in which a significant radiographic change was incorrectly predicted. Thirty five (43.2%) of these 81 chest radiographs had unpredicted pulmonary findings and 46 (56.8%) showed unpredicted appliance malpositions. Incorrect predictions were significantly associated with radiographs from patients who were younger, intubated, mechanically ventilated, and had indwelling central venous catheters. Level of training of the predicting physicians did not affect prediction accuracy. In analysis of 43 routine postintubation chest radiographs and 39 routine postcentral venous catheter placement chest radiographs, appliance malpositions were disclosed in 34.9% and 43.6%, respectively. Routine daily and postappliance placement chest radiographs have significant clinical value in the pediatric intensive care unit.

Key Words: chest radiographs • intensive care • central venous catheters • endotracheal tube

Submitted on July 11, 1988




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