Role of X ray chest in Paediatric intensive care unit (PICU): Is it a good predictor of outcome ?
Abstract
Introduction: ICU patients are prone to several cardiopulmonary disorders which when superimposed on the underlying pathology that prompted admission create a complex radiological appearance, which may be difficult to interpret on the basis of imaging findings alone. Our objective is to assess whether radiographic findings predict outcomes among children hospitalized with pneumonia.
Material and Methods: A retrospective study of 127 cases was carried out in the Department of Radio Diagnosis, who were referred for a Chest radiograph evaluation from PICU. Patients with complaint suggestive of acute cardiopulmonary and systemic illness on the basis of clinical/laboratory/ultrasonography findings / who were referred for a radiographs evaluation of the cardiopulmonary. Several measures of disease severity were assessed. The severity of the illness was evaluated and the outcome parameters was calculated using the chi square test.
Results: There were 127 patients of less than 12 years taken in study in which 74 were males and 53 were females, in which 27% were of cardiac illness, 46% of respiratory illness, 13% of CNS, 9% routine X ray and 5% of others. radiological findings in cardiac patient shows that maximum 91.11% of patents have cardiomegaly followed by consolidation , effusion and minimum number have normal findings and in respiratory cases, maximum patients shows consolidation (71.11%) followed by increased vascular markings(54.33%), infilterate (23.72%), effusion16.9%), normal (0.084%) and cardiomegaly (0.05%).
Conclusion: Admission radiographic findings are associated with important hospital outcomes and care processes and may help to predict disease severity. Chest radiograph adds on for evaluation of available, appropriate diagnostic and therapeutic interventions in critically patients in PICU.
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References
2. Graat ME, Spronk PE, Schultz MJ. Current practice of chest radiography in critically ill patients in the Nether-lands: a postal survey. Chest 128:S296.
3. Don M, Fasoli L, Paldanius M, Vainionpaa R,Kleemola M, Raty R, et al. Aetiology of community-acquired pneumonia: serological results of a paediatric survey. Scand J Infect Dis 2005; 37: 806-812.
4. Michelow IC, Olsen K, Lozano J, Rollins NK, Duffy LB, Ziegler T, Kauppila J, Leinonen M, McCracken GH Jr.Epidemiology and clinical characteristics of community -acquired pneumonia in hospitalized children. Pediatrics. 2004 Apr;113(4):701-7.
5. Lessnau KD. Is chest radiography necessary after uncomplicated insertion of a triple-lumen catheter in the right internal jugular vein, using the anterior approach? Chest. 2005;4(1):220–223. doi: 10.1378/chest.127.1.220.
6. Lucey B, Varghese JC, Haslam P, Lee MJ. Routine chest radiographs after central line insertion: mandatory postprocedural evaluation or unnecessary waste of resources?CardiovascInterventRadiol. 1999;4(5):381–384
7. Sanabria A, Henao C, Bonilla R, Castrillón C, Cruz H, Ramírez W, Navarro P, González M, Díaz A. Routine chest roentgenogram after central venous catheter insertion is not always necessary. Am J Surg. 2003;4(1): 35–39. doi: 10.1016/S0002-9610(03)00122-3.
8. Abood GJ, Davis KA, Esposito TJ, Luchette FA, Gamelli RL. Comparison of routine chest radiograph versus clinician judgment to determine adequate central line placement in critically ill patients. J Trauma. 2007;4(1):50–56. doi: 10.1097/TA.0b013e31806bf1a3.
9. Brunel W, Coleman DL, Schwartz DE, Peper E, Cohen NH. Assessment of routine chest roentgenograms and the physical examination to confirm endotracheal tube position. Chest. 1989;4(5):1043–1045. doi: 10.1378/chest. 96.5.1043.
10. Lotano R, Gerber D, Aseron C, Santarelli R, Pratter M. Utility of postintubation chest radiographs in the intensive care unit. Crit Care. 2000;4(1):50–53. doi: 10.1186/cc650.
11. Hornick PI, Harris P, Cousins C, Taylor KM, Keogh BE. Assessment of the value of the immediate postoperative chest radiograph after cardiac operation. Ann ThoracSurg. 1995;4(5):1150–1153. doi: 10.1016/ 0003-4975(95)00087-2. Discussion 1153-4.
12. Karthik S, O'Regan DJ. An audit of follow-up chest radiography after coronary artery bypass graft. Clin Radiol. 2006 Jul;61(7):616-8.
13. Graat ME, Choi G, Wolthuis EK, Korevaar JC, Spronk PE, Stoker J, Vroom MB, Schultz MJ. The clinical value of daily routine chest radiographs in a mixed medical-surgical intensive care unit is low. Crit Care. 2006;4(1):R11.
14. Graat ME, Kroner A, Spronk PE, Korevaar JC, Stoker J, Vroom MB, Schultz MJ. Elimination of daily routine chest radiographs in a mixed medical-surgical intensive care unit. Intensive Care Med. 2007;4(4):639–644. doi: 10.1007/s00134-007-0542-1.
15. Hendrikse KA, Gratama JW, Hove W, Rommes JH, Schultz MJ, Spronk PE. Low value of routine chest radiographs in a mixed medical-surgical ICU. Chest. 2007; 4(3):823–828. doi: 10.1378/chest.07-1162.
16. Kager LM, Kröner A, Binnekade JM, Gratama JW, Spronk PE, Stoker J, Vroom MB, Schultz MJ. Review of a large clinical series: the value of routinely obtained chest radiographs on admission to a mixed medical–surgical intensive care unit. J Intensive Care Med. 2010;4 (4):227–232. doi: 10.1177/0885066610366925.
17. Hall JB, White SR, Karrison T. Efficacy of daily routine chest radiographs in intubated, mechanically ventilated patients. Crit Care Med. 1991;4(5):689–693. doi: 10.1097/00003246-199105000-00015.
18. Bhagwanjee S, Muckart DJ. Routine daily chest radiography is not indicated for ventilated patients in a surgical ICU. Intensive Care Med. 1996;4(12):1335–1338. doi: 10.1007/BF01709547.
19. Clec'h C, Simon P, Hamdi A, Hamza L, Karoubi P, Fosse JP, Gonzalez F, Vincent F, Cohen Y. Are daily routine chest radiographs useful in critically ill, mechanically ventilated patients? A randomized study. Intensive Care Med. 2008;4(2):264–270. doi: 10.1007/s 00134-007-0919-1.
20. Leppek R, Bertrams SS, Höltermann W, Klose KJ Radiation exposure during thoracic radiography at the intensive care unit. Dose accumulation and risk of radiation-induced cancer in long-term therapy. Radiologe. 1998 Sep; 38(9):730-6.
21. Meade MO, Cook RJ, Guyatt GH, Groll R, Kachura JR, Bedard M, Cook DJ, Slutsky AS, Stewart TE Interobserver variation in interpreting chest radiographs for the diagnosis of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2000 Jan; 161(1): 85-90.
22. Guo W, Wang J, Sheng M, Zhou M, Fang L. Radiological findings in 210 paediatric patients with viral pneumonia: a retrospective case study. Br J Radiol. 2012 Oct; 85 (1018):1385-9. doi: 10.1259/bjr/20276974. Epub 2012 Apr 18.
23. Wan-liang Guo, Jian Wang, Differentiation between mycoplasma and viral community-acquired pneumonia in children with lobe or multi foci infiltration: a retros-pective case study BMJ Open. 2015; 5(1): e006766.
24. N Mueller‐Lenke, J Rudez Use of chest radiography in the emergency diagnosis of acute congestive heart failure Heart. 2006 May; 92(5): 695–696.
25. Al aseri Z. Accuracy of chest radiograph inter-pretation by emergency physicians. Emerg Radiol. 2009 Mar;16(2):111-4. doi: 10.1007/s10140-008-0763-9. Epub 2008 Sep 9.
