• Shelby Resnick, Kenji Inaba, Efstathios Karamanos, Dimitra Skiada, James A Dollahite, Obi Okoye, Peep Talving, and Demetrios Demetriades.
• University of Southern California, Keck School of Medicine, Department of Surgery, Division of Acute Care Surgery, Los Angeles County General Hospital (LAC+USC), Los Angeles, CA, USA. Electronic address: shelby.resnick@uphs.upenn.edu.
• Am. J. Surg. 2017 Jul 1; 214 (1): 19-23.

IntroductionA daily Chest X-ray (CXR) is obtained in many surgical intensive care units (SICU). This study implemented a selective CXR protocol in a high volume, academic SICU and evaluated its impact on clinical outcomes.MethodsAll SICU patients admitted in 2/2010 were compared with patients admitted in 2/2012. Between the time periods, a protocol eliminating the routine daily CXRs was instituted.ResultsIn 02/2010 and 02/2012, 107 and 90 patients were admitted to the SICU, respectively, for a total of 1384 patient days. CXRs decreased from 365 (57.1% of patient-days) in 2010 to 299 (40.9% of patient days; p < 0.001) in 2012. A greater proportion of Physician Directed CXRs (PDCXRs) had new findings (80.8%) compared to Automatic Daily CXRs (ADCXRs) (23.5%, p < 0.001). There was no difference in overall or SICU length of stay, ventilator-free days, morbidity or mortality.ConclusionEliminating ADCXRs decreased the number of CXRs performed, without affecting LOS, mechanical ventilation, morbidity or mortality. Physician-directed ordering of CXRs increased the diagnostic value of the CXR and decreased the number of clinically irrelevant CXRs performed.Copyright © 2016 Elsevier Inc. All rights reserved.

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