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Critical Care

, 16:R68

First Online: 27 April 2012Received: 08 November 2011Revised: 14 February 2012Accepted: 27 April 2012


IntroductionChest 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.

MethodsWe 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.

ResultsNine studies 39,358 CXRs; 9,611 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 one 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% confidence interval CI 0.84 to 1.28, P = 0.72; two trials, N = 776, hospital mortality RR 0.98, 95% CI 0.68 to 1.41, P = 0.91; two 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; three trials, N = 870, hospital length of stay WMD -2.50 days, 95% CI -6.62 to 1.61 days, P = 0.23; two trials, N = 259, or duration of mechanical ventilation WMD -0.30 days, 95% CI -1.48 to 0.89 days, P = 0.62; three trials, N = 705. Adding data from six observational studies, one of which systematically screened for missed findings, gave similar results.

ConclusionsThis 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.

AbbreviationsCIconfidence interval

CXRchest x-ray

ICCintracluster correlation coefficient

ICUintensive care unit

RCTrandomized controlled trial

RRrisk ratio

WMDweighted mean difference.

Electronic supplementary materialThe online version of this article doi:10.1186-cc11321 contains supplementary material, which is available to authorized users.

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Autor: Anusoumya Ganapathy - Neill KJ Adhikari - Jamie Spiegelman - Damon C Scales


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