Influence of Chest X-ray vs. Chest CT Scan on the Management of ICU Patients With Respiratory Failure

Patients admitted to the intensive care unit (ICU) often require CT imaging. Performing this test on a critically ill patient involves risks, such as those associated with transferring a ventilated and unstable patient (respiratory or hemodynamic instability during transfer, unplanned extubation, unplanned removal of central catheters, drains, etc.), and those associated with intravenous contrast injection (renal impairment, anaphylactic reaction). Additionally, multiple CT scans may create a burden on the radiology department and medical staff, cause CT scans to be postponed for other patients, and increase hospitalization costs (1). In a study conducted in 2014, approximately 533 CT scans were performed for 359 patients admitted to the ICU at 2 different medical centers. In this study, they examined the extent to which CT scanning affected patient care management by comparing the medical diagnosis given to the patient before and after the scan. The diagnostic yield of the scan was 40% complete agreement between the diagnosis before and after the CT scan, about 6% partial agreement, and about 54% inconsistency. The CT scan resulted in new findings in the patient's diagnosis in 23% of cases, and in 54% of patients, the CT scan resulted in a change in the patient's treatment plan. Among the patients who underwent a CT scan, about 23% experienced side effects or adverse events as a result of the scan, of which 6% were defined as life-threatening. The more critically ill the patient was, the greater the risk of these events (1). In another study, which looked at a subgroup of septic patients in intensive care, there was no agreement between CT findings and the patients' treatment outcomes, and there was no significant effect of the CT scan on the patient's treatment plan (2). In our previous work on all patients who underwent CT scans in the unit, we found that, in general, the rate of impact of CT scans on the patient's treatment plan was low compared to other st