Routine chest x-rays in intensive care units: a systematic review and meta-analysis.
Crit Care. 2012 Apr 27;16(2):R68
Authors: Ganapathy A, Adhikari NK, Spiegelman J, Scales DC
ABSTRACT: INTRODUCTION: Chest x-rays (CXRs) are the most frequent radiological tests performed in the intensive care unit (ICU). However, the utility of performing daily routine CXRs is unclear. METHODS: We searched Medline and Embase (1948 to March 2011) for randomized and quasi-randomized controlled trials (RCTs) and before-after observational studies comparing a strategy of routine CXRs to a more restrictive approach with CXRs performed to investigate clinical changes among critically ill adults or children. In duplicate, we extracted data on the CXR strategy, study quality and clinical outcomes (ICU and hospital mortality; duration of mechanical ventilation and ICU and hospital stay). RESULTS: Nine studies (39358 CXRs, 9611 patients) were included in the meta-analysis. Three trials (N=870) of moderate to good quality provided information on the safety of a restrictive routine CXR strategy; only 1 trial systematically assessed for missed findings. Pooled data from trials showed no evidence of effect of a restrictive approach on ICU mortality (risk ratio [RR] 1.04, 95% CI 0.84 to 1.28, P=0.72; 2 trials, N=776), hospital mortality (RR 0.98, 95% CI 0.68 to 1.41, P=0.91; 2 trials, N=259), ICU length of stay (weighted mean difference [WMD] -0.86 days, 95% CI -2.38 to 0.66 days, P=0.27; 3 trials, N=870), hospital length of stay (WMD -2.50 days, 95% CI -6.62 to 1.61 days, P=0.23; 2 trials, N= 259), or duration of mechanical ventilation (WMD -0.30 days, 95% CI -1.48 to 0.89 days, P=0.62; 3 trials, N=705). Adding data from 6 observational studies, 1 of which systematically screened for missed findings, gave similar results. CONCLUSIONS: This meta-analysis did not detect any harm associated with a restrictive chest radiograph strategy. However, confidence intervals were wide and harm was not rigorously assessed. Therefore, the safety of abandoning routine CXRs in patients admitted to the ICU remains uncertain.
PMID: 22541022 [PubMed – as supplied by publisher]