The Influence of Chest CT Versus. Chest x-ray on the Management of Critically ill Patients: A Retrospective Study

Purpose Critically ill patients admitted to the intensive care unit (ICU) often require computed tomography (CT) imaging. Previous studies have demonstrated the role of CT in this population in terms of changes in diagnosis and/or management, particularly among subgroups such as septic patients. In this study, we included ICU patients who underwent chest CT due to acute respiratory failure, and examined specifically whether chest x-ray (CXR) identified all findings later seen on CT, whether CT revealed additional diagnostic findings, and, importantly, whether these new findings led to changes in clinical management. Methods Retrospective data collection from computerized medical systems regarding patients who underwent chest CT during ICU hospitalization with an indication of acute respiratory failure, from January 2020 to January 2023. The cohort included 45 patients who underwent 55 CT scans, which were compared to 55 corresponding chest x-rays. Demographic and in-hospital data were collected, as well as findings from both CT and CXR. Results A total of 45 patients undergoing 55 chest CT scans were included. The mean age was 55.24 years (SD = 19.6), and 60% were male. The main reasons for ICU admission were infection/sepsis (48.8%), primary respiratory failure (31.1%), and trauma (13.3%). Chest CT was performed after a median of 5 days [IQR 1–14] from ICU admission. Intravenous contrast was used in 52 cases (94.5%). CT identified new findings contributing to diagnosis in 31 scans (56.4%, 95% CI 43.3-68.6%). These new findings led to changes in clinical management in 17 cases (30.9%, 95% CI 20.3-44.0%), most commonly involving an invasive intervention. Conclusion Among critically ill ICU patients undergoing evaluation for acute respiratory failure, chest CT contributed to diagnosis in over half of cases and changed patient management in one-third of cases compared with chest x-ray. Further studies are needed to confirm these findings. Registration no NCT07256860.