Routine Chest Radiographs in Children After Image-Guided Central Lines Offer Little Diagnostic Value

Aaron J. Cunningham, Meredith B. Haag, Kristen V. McClellan, Sanjay Krishnaswami, Nicholas A. Hamilton

Research output: Contribution to journalArticle

Abstract

Background: The aim of this study was to investigate the utility of postoperative chest radiograph (CXR) after image-guided central venous line (CVL) placement in children. Methods: A retrospective review was conducted of all tunneled CVLs placed at two pediatric institutions from 2010 to 2017. A subgroup analysis comparing a clinically driven approach to postoperative imaging against routine imaging was performed. Results: During the study period, 1080 lines were placed in 915 patients. There were 892 postoperative CXRs (82.6%). An abnormality was seen on 40 radiographs (4.5%, n = 891), with 16 false-positive (1.3%) and 5 false-negative (0.6%) CXRs. The sensitivity and specificity of CXR to identify complications requiring intervention were 50.0% (95% confidence interval [95% CI], 10.0-90.0) and 95.8% (95% CI, 94.5-97.1), respectively. Positive predictive value of CXR was 7.5% (95% CI, 0-15.7) with a negative predictive value of 99.6% (95% CI, 99.2-100). A clinically driven approach to postoperative imaging was associated with 41% decrease in CXR (P < 0.001) without increased incidence of missed complications. Only three complications requiring intervention (0.3%) were suspected on postoperative CXR alone, and all of those were symptomatic before intervention. Conclusions: Routine postoperative CXR offers minimal value in identifying technical complications requiring intervention after image-guided CVL placement in asymptomatic children. We recommend abandoning this practice in favor of a clinical symptom-driven approach to postoperative imaging.

Original languageEnglish (US)
JournalJournal of Surgical Research
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Thorax
Confidence Intervals
Pediatrics
Sensitivity and Specificity
Incidence

Keywords

  • Central venous line
  • Chest radiograph
  • Pediatric
  • Resource utilization

ASJC Scopus subject areas

  • Surgery

Cite this

Routine Chest Radiographs in Children After Image-Guided Central Lines Offer Little Diagnostic Value. / Cunningham, Aaron J.; Haag, Meredith B.; McClellan, Kristen V.; Krishnaswami, Sanjay; Hamilton, Nicholas A.

In: Journal of Surgical Research, 01.01.2019.

Research output: Contribution to journalArticle

@article{5d267c413b954bec853b27d16554af22,
title = "Routine Chest Radiographs in Children After Image-Guided Central Lines Offer Little Diagnostic Value",
abstract = "Background: The aim of this study was to investigate the utility of postoperative chest radiograph (CXR) after image-guided central venous line (CVL) placement in children. Methods: A retrospective review was conducted of all tunneled CVLs placed at two pediatric institutions from 2010 to 2017. A subgroup analysis comparing a clinically driven approach to postoperative imaging against routine imaging was performed. Results: During the study period, 1080 lines were placed in 915 patients. There were 892 postoperative CXRs (82.6{\%}). An abnormality was seen on 40 radiographs (4.5{\%}, n = 891), with 16 false-positive (1.3{\%}) and 5 false-negative (0.6{\%}) CXRs. The sensitivity and specificity of CXR to identify complications requiring intervention were 50.0{\%} (95{\%} confidence interval [95{\%} CI], 10.0-90.0) and 95.8{\%} (95{\%} CI, 94.5-97.1), respectively. Positive predictive value of CXR was 7.5{\%} (95{\%} CI, 0-15.7) with a negative predictive value of 99.6{\%} (95{\%} CI, 99.2-100). A clinically driven approach to postoperative imaging was associated with 41{\%} decrease in CXR (P < 0.001) without increased incidence of missed complications. Only three complications requiring intervention (0.3{\%}) were suspected on postoperative CXR alone, and all of those were symptomatic before intervention. Conclusions: Routine postoperative CXR offers minimal value in identifying technical complications requiring intervention after image-guided CVL placement in asymptomatic children. We recommend abandoning this practice in favor of a clinical symptom-driven approach to postoperative imaging.",
keywords = "Central venous line, Chest radiograph, Pediatric, Resource utilization",
author = "Cunningham, {Aaron J.} and Haag, {Meredith B.} and McClellan, {Kristen V.} and Sanjay Krishnaswami and Hamilton, {Nicholas A.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jss.2019.10.019",
language = "English (US)",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Routine Chest Radiographs in Children After Image-Guided Central Lines Offer Little Diagnostic Value

AU - Cunningham, Aaron J.

AU - Haag, Meredith B.

AU - McClellan, Kristen V.

AU - Krishnaswami, Sanjay

AU - Hamilton, Nicholas A.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The aim of this study was to investigate the utility of postoperative chest radiograph (CXR) after image-guided central venous line (CVL) placement in children. Methods: A retrospective review was conducted of all tunneled CVLs placed at two pediatric institutions from 2010 to 2017. A subgroup analysis comparing a clinically driven approach to postoperative imaging against routine imaging was performed. Results: During the study period, 1080 lines were placed in 915 patients. There were 892 postoperative CXRs (82.6%). An abnormality was seen on 40 radiographs (4.5%, n = 891), with 16 false-positive (1.3%) and 5 false-negative (0.6%) CXRs. The sensitivity and specificity of CXR to identify complications requiring intervention were 50.0% (95% confidence interval [95% CI], 10.0-90.0) and 95.8% (95% CI, 94.5-97.1), respectively. Positive predictive value of CXR was 7.5% (95% CI, 0-15.7) with a negative predictive value of 99.6% (95% CI, 99.2-100). A clinically driven approach to postoperative imaging was associated with 41% decrease in CXR (P < 0.001) without increased incidence of missed complications. Only three complications requiring intervention (0.3%) were suspected on postoperative CXR alone, and all of those were symptomatic before intervention. Conclusions: Routine postoperative CXR offers minimal value in identifying technical complications requiring intervention after image-guided CVL placement in asymptomatic children. We recommend abandoning this practice in favor of a clinical symptom-driven approach to postoperative imaging.

AB - Background: The aim of this study was to investigate the utility of postoperative chest radiograph (CXR) after image-guided central venous line (CVL) placement in children. Methods: A retrospective review was conducted of all tunneled CVLs placed at two pediatric institutions from 2010 to 2017. A subgroup analysis comparing a clinically driven approach to postoperative imaging against routine imaging was performed. Results: During the study period, 1080 lines were placed in 915 patients. There were 892 postoperative CXRs (82.6%). An abnormality was seen on 40 radiographs (4.5%, n = 891), with 16 false-positive (1.3%) and 5 false-negative (0.6%) CXRs. The sensitivity and specificity of CXR to identify complications requiring intervention were 50.0% (95% confidence interval [95% CI], 10.0-90.0) and 95.8% (95% CI, 94.5-97.1), respectively. Positive predictive value of CXR was 7.5% (95% CI, 0-15.7) with a negative predictive value of 99.6% (95% CI, 99.2-100). A clinically driven approach to postoperative imaging was associated with 41% decrease in CXR (P < 0.001) without increased incidence of missed complications. Only three complications requiring intervention (0.3%) were suspected on postoperative CXR alone, and all of those were symptomatic before intervention. Conclusions: Routine postoperative CXR offers minimal value in identifying technical complications requiring intervention after image-guided CVL placement in asymptomatic children. We recommend abandoning this practice in favor of a clinical symptom-driven approach to postoperative imaging.

KW - Central venous line

KW - Chest radiograph

KW - Pediatric

KW - Resource utilization

UR - http://www.scopus.com/inward/record.url?scp=85075532751&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85075532751&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2019.10.019

DO - 10.1016/j.jss.2019.10.019

M3 - Article

C2 - 31706543

AN - SCOPUS:85075532751

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

ER -