Cruz Jeffrey, Ferra Michael, Kasarabada Aditya, Gasperino James, Zigmund Beth
Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA Department of Radiologic Sciences, Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA, USA.
J Intensive Care Med. 2016 Jun;31(5):333-7. doi: 10.1177/0885066614538393. Epub 2014 Jun 10.
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.
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.
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%).
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.
由于成本高昂以及某些放射检查对患者和工作人员造成辐射暴露，影像检查程序的使用受到密切审查。在我们机构的重症监护病房（ICU），气管造口管置入后患者不仅通常会立即进行胸部X线摄影（CR），而且无论患者临床状况如何，每天都会进行。我们假设对气管造口管患者进行常规每日CR的临床效用较低，并会导致不必要的财务成本。
对2010年4月至2011年7月期间79例ICU气管造口患者进行的761次CR进行回顾性病历审查。我们在761次CR的放射学报告中查找新的影像学检测到的并发症，并审查病历以确定哪些并发症是临床怀疑的，以及哪些放射学报告导致了患者管理的改变。
在761次CR中，只有18次（2.3%）X线片显示新的并发症。所有并发症在影像学检查前均为临床怀疑。只有5次（0.7%）并发症导致了管理改变。最常见的管理改变是抗生素方案的改变（0.3%）和利尿剂的医嘱（0.3%）。
ICU中气管造口患者的常规每日影像学检查临床效用不大，该人群的CR应根据患者的临床状况进行选择性实施。
