Don’t order routine investigations including chest radiographs or blood tests in critically ill patients, except to answer a specific clinical question.

Chest radiographs (“X-rays”, CXRs) are not indicated for routine assessment of critically-ill patients except following specific procedures (e.g., endotracheal tube, naso- or orogastric tube, central vein catheter, or other procedure requiring verification after insertion), or to provide information for a specific question related to a change in patient’s clinical condition. This includes during cases of suspected or confirmed COVID-19. Blood tests should be ordered to monitor a specific clinical condition, or to answer a specific clinical question. At a minimum, the need for recurring or repetitive blood tests should be reassessed daily.

 

Sources:

Amorosa JK, Bramwit MP, Mohammed TL, Reddy GP, Brown K, Dyer DS, Ginsburg ME, Heitkamp DE, Jeudy J, Kirsch J, MacMahon H, Ravenel JG, Saleh AG, Shah RD. ACR appropriateness criteria routine chest radiographs in intensive care unit patients. J Am Coll Radiol. 2013 Mar;10(3):170-4. PMID: 23571057.

Ganapathy A, et al. Routine chest x-rays in intensive care units: a systematic review and meta-analysis. Crit Care. 2012 Dec 12;16(2):R68. PMID: 22541022.

Eaton KP et al. Evidence-based guidelines to eliminate repetitive laboratory testing. JAMA Intern Med. 2017;177(12):1833-9. PMID: 29049500.

Kotecha N et al. Reducing Unnecessary Laboratory Testing in the Medical ICU. Am J Med. 2017 Jun;130(6):648-651. PMID: 28285068

Routine Blood Tests for Patients in the Intensive Care Unit: Clinical Effectiveness, Cost-Effectiveness, and Guidelines. CADTH. August 16, 2013