LAUSR

Introduction/Hypothesis: Protocols reducing routine daily CXR (chest X-ray) orders in adult ICUs have successfully decreased CXR utilization without detracting from care. This has not had the same level of analysis in the pediatric ICU (PICU) population. This study aims to elucidate the utility of daily routine CXRs in a modern, large, quaternary PICU setting. Methods: Retrospective observational study on patients admitted to the PICU at a large freestanding quaternary care children’s hospital. Data for routine and PRN (as needed) CXR usage, patient demographics, respiratory support, and admitting diagnosis was collected on 160 CXRs through chart review. Management changes made as a result of the CXR were determined by detailed analysis of the radiologist CXR interpretations, provider notes, and changes in respiratory support, medication usage, and pulmonary clearance therapies. Results: Initial results show an average of 13.3 CXRs were done per day with 5.7 (43%) leading to a change in management. Routine daily CXRs averaged to 7.4 per day (56% of total CXRs) with 1.8 (24%) resulting in management change. PRN CXRs averaged to 5.9 per day with 3.9 (66%) resulting in management change. Patients with a primary respiratory diagnosis received 76% of daily CXRs and 73% of PRN CXRs. Patients with endotracheal tubes (ETT) received 63% of daily CXRs and 56% of PRN CXRs with 36% of daily CXRs and 66% of PRN CXRs leading to management change. Of all unplanned ETT extubations, 8% occurred secondary to the ETT being moved after a daily CXR. Patients with tracheostomy tubes, high flow nasal cannula, or BiPAP comprised of 37% of daily CXRs and 44% of PRN CXRs; out of those, 10% of daily CXRs and 62% of PRN CXRs led to a change in management. Conclusions: Routine daily CXRs have a low likelihood of leading to a change in clinical management, especially for non-intubated patients, in the PICU setting. Additionally, obtaining daily CXRs or re-adjustment of ETTs after daily CXRs can lead to unanticipated ETT extubations. More research is needed to determine specific indications and patient populations that benefit the most from daily CXRs and allow us to safely decrease daily CXR usage.