Hauser G J, Pollack M M, Sivit C J, Taylor G A, Bulas D I, Guion C J
Departments of Critical Care Medicine, Children's Hospital, National Medical Center, Washington, DC 20010.
Pediatrics. 1989 Apr;83(4):465-70.
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 post-appliance placement chest radiographs have significant clinical value in the pediatric intensive care unit.
在一家儿科重症监护病房对常规胸部X光片的临床价值进行了前瞻性评估。要求医生在检查101例患者后，对101例患者进行的353张常规晨间胸部X光片的临床影响结果进行预测。在81例（23%）中，胸部X光片的临床影响被错误预测，如果没有胸部X光片，管理上的重大改变可能会被遗漏。这81张胸部X光片包括72例具有临床意义的未预测到的X光片变化，以及9例X光片变化被错误预测的胸部X光片。这81张胸部X光片中，35例（43.2%）有未预测到的肺部表现，46例（56.8%）显示有未预测到的器械位置不当。错误预测与年龄较小、插管、机械通气以及留置中心静脉导管患者的X光片显著相关。预测医生的培训水平不影响预测准确性。在对43例插管后常规胸部X光片和39例中心静脉导管置入后常规胸部X光片的分析中，器械位置不当分别在34.9%和43.6%的病例中被发现。儿科重症监护病房的常规每日胸部X光片和器械置入后胸部X光片具有重要的临床价值。
