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Chest radiographs in 104 French ICUs: current prescription strategies and clinical value (the RadioDay study)

Karim Lakhal| Marianne Serveaux-Delous| Jean Yves Lefrant| Xavier Capdevila| Samir Jaber
Original
Volume 38, Issue 11 / November , 2012

Pages 1787 - 1799

Abstract

Objective

To analyze the current practices of chest radiograph (CXR) prescription and their clinical impact.

Design

Prospective snapshot observational study (on RadioDay) combined with a survey.

Patients

Patients who were given a CXR on RadioDay.

Setting

One hundred four French intensive care units (ICUs).

Results

On RadioDay, 854 CXRs (in 804 patients) were ordered. For the “CXRs morning round,” the prescription policy was declared to be “on-demand” (in 63 % of the ICUs), “daily routine only in mechanically ventilated patients (MV)” (30 %) or, less frequently, “daily routine in all patients” (7 %). When analyzing the two main local policies, as compared with “daily routine only in MV” ICUs, in “on-demand” ICUs: (1) fewer CXRs were ordered (0.6 ± 0.3 vs. 0.9 ± 0.2 CXRs/patient, p < 0.001) with no increase in the rate of unscheduled CXRs (i.e., CXRs performed outside the morning round), and (2) individual CXRs were more often followed by a therapeutic intervention (which would not have occurred without the CXR): 34 vs. 25 % of the CXRs (p < 0.05). Last, in case of severe respiratory disease (low PaO2/FiO2 ratio), it is noteworthy that the clinical value of “on-demand” individual CXRs was still markedly higher than that of “daily routine” CXRs.

Conclusion

Nearly two-thirds of the participating ICUs adopted the “on-demand” strategy of prescription, which was associated with a lower rate of CXRs with no increase in unscheduled CXRs and was of higher clinical value than a “daily routine in MV” strategy. Importantly, the study design did not allow assessing if the “on-demand” strategy had missed or delayed some diagnoses.

Keywords

References

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