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Indian Journal of Trauma and Emergency Pediatrics

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Decisions and Outcomes after Chest X-ray in Pediatric Intensive Care Unit

Sudha Chandelia, Associate Professor, Division of Pediatric Critical Care, Department of Pediatrics, PGIMER and associated Dr. R.M.L Hospital, New Delhi, Delhi 110001 , India , Sudha Chandelia1 , Sunil Kishore2 , Devki Nandan3 , Sarita Jilowa4

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Indian Journal of Trauma and Emergency Pediatrics 10(4):p 103-108, Oct-Dec 2018. | DOI: DOI: http://dx.doi.org/10.21088/ijtep.2348.9987.10418.2

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Abstract

  Background: Chest X-ray (CXR) is an important diagnostic and interventional imaging modality in critically sick children admitted in PICU. But the data on their association with clinical decisions and interventions are scant. Methods: It was a retrospective descriptive study conducted in PICU. A total of 60 consecutive children aged one month to 14 years were included and all CXR done on those during PICU stay constituted the sample size. We collected data on indication of CXR, diagnosis on CXR and matching of indication and diagnosis, decision and actions taken after CXR. Results: A total of 200 CXR were available. Mean number of CXR per patient were 3.67. At 1st day of admission CXR was done for almost all the patients. The interventions were done in 32 events based on CXR findings while in 40 events there were no interventions associated with CXR. Longer duration of PICU stay, ARDS and persistent pneumonia were associated with increased number of CXR. There was good matching of clinical diagnosis and CXR diagnosis as in a very few cases diagnosis was picked up on CXR when it was missed on clinical assesment. Conclusion: A good number of CXR can be avoided like post intubation for ET position, daily CXR in ARDS. Although pre-extubation CXR were associated with action but we opine these can be avoided and patients can be extubated on clinical judgement. Some baseline X ray for bronchiolitis and GBS could have been avoided.

Keywords: Chest X-ray; Pneumonia; PICU; Ventilator Associated Pneumonia; VAP; ARDS; Pediatric.

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DOI: DOI: http://dx.doi.org/10.21088/ijtep.2348.9987.10418.2

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