Utility of Chest Radiographs (CXR) in Paediatric Critical Care Setting

Background and aims: XRays have become frequently used imaging tools in the Critical Care setting. CXRs (Chest Xrays) are used either to support clinical decision making and result in therapeutic changes or are used to confirm adequacy of current interventions and remain unchanged. This is a retrospective study aimed at evaluating the number of CXRs our patients receive and how the management of patients is influenced by such CXR.

Methods: All patients admitted during Oct–Nov 2017 on Paediatric Critical Care Unit at Royal London Hospital who have undergone at least one CXR per admission in the PCCU. Patients who have received only other XRays – such as abdominal, neck, pelvis, etc. will not be included in the study.

Clinical Data collection: Age of patient, PIM Score, Primary Diagnosis, Length of stay, Type of ventilation – invasive / non-invasive, Number of CXR received during admission, Indication for request, Routine – (e.g. Line/ET check), Urgent Xrays – (e.g. Clinical suspicion of pneumothorax/effusion), Change in management following CXR

Results: There have been 91 patients admitted between 01.10 -30.11.17. Of these, 74 had at least one CXR done. Total 141 of xrays. Average length of admission - 5.2 days/patient. Average of 2.1 CXR/patient. Average PIM score of patients - 33.5%. 79 of the xrays have been requested for urgent reasons (56%) whereas (44%) for routine actions. 47 of the urgent Xray were followed by a change in management (33.4% of total xrays and 55% of the urgent ones)

Conclusions: All our CXR have been requested based on clinical reasons and more than half of them had urgent indication. More than half of the urgent Xrays were followed by a change in management (1/3 of total). Although our study is not large, we conclude that CXR should be performed based on clinical indication only.