Thoracic CT in the intensive care unit: assessment of clinical usefulness

PURPOSE: To determine the clinical usefulness of thoracic computed tomography (CT) in patients in a general intensive care unit (ICU).

MATERIALS AND METHODS: Images obtained in 108 consecutive thoracic CT examinations and the associated bedside chest radiographs and medical records in 85 patients (55 men, 30 women; age range, 19-92 years) in the ICU of an institution were retrospectively reviewed. CT findings were compared with concurrent bedside chest radiographic findings. The clinical importance of each CT finding was determined by reviewing the clinical record.

RESULTS: Of the 232 chest radiographic findings, 199 (86%) were confirmed at CT; when disagreement about mild congestive heart failure was excluded, there was a 93% agreement (199 of 213 findings). However, only CT demonstrated 250 (52%) of the 482 total findings (232 + 250 findings). Although many of these new findings were not clinically important, 32 (30%) of the 108 CT examinations had at least one new clinically important finding. These important new findings most often were (a) abscesses or postoperative fluid collections in the mediastinum, chest wall, or retroperitoneum; (b) malignancies that were detected, staged, or evaluated; (c) unsuspected pneumonia; or (d) pleural effusions. The CT findings resulted in changes in clinical management in 24 (22%) of the 108 examinations.

CONCLUSION: CT of the thorax is clinically useful in selected situation in patients in ICUs.