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  • Poster presentation
  • Open Access

Prescription and clinical impact of chest radiographs in 104 French ICUs: the RadioDay Study

  • 1,
  • 1,
  • 1,
  • 2,
  • 3 and
  • 1
Critical Care201115 (Suppl 1) :P137

https://doi.org/10.1186/cc9557

  • Published:

Keywords

  • Chest Radiograph
  • Chest Tube
  • Routine Chest
  • Device Placement
  • Tube Removal

Introduction

Prescribing daily routine chest radiographs (CXRs) in ICU patients is a matter for debate. We aimed at describing current strategies of CXR prescriptions and their diagnostic and therapeutic impacts in a large panel of French ICUs.

Methods

We performed a postal survey recording ICU habits of CXR prescription and a snapshot single-day (called RadioDay) observational study analyzing all of the prescribed CXRs.

Results

Survey

(n = 104 ICUs) CXR prescription was made on a daily routine basis for every patient and only in mechanically ventilated patients in 7% and 37% of the 104 ICUs, respectively. Depending on the ICUs, ICU admission (55% of the ICUs), endotracheal intubation (87%), tracheostomy (87%), superior vena cava device (96%), nasogastric tube (48%), chest tube insertion (98%) and chest tube removal (60%) were systematically followed by a CXR. A written procedure for CXR prescription was available in 12% ICUs.

Snapshot study

On RadioDay, 854 CXRs were performed (8.2 ± 4.6 per center) in 804 patients: 36.5% were prescribed on a daily routine basis. The most frequent indications for on-demand CXR were: follow-up of pleuropulmonary pathology (32%), control after invasive device placement (20%), search for an etiology of respiratory or circulatory failure (13%) and ICU admission (11%). On-demand CXRs were mostly (62%) performed during the morning round. On-demand CXR showed more frequently a tissue abnormality than daily routine CXR (69 vs. 48%, P < 0.001) and this radiographic finding was unexpected in 20 and 15%, respectively (P = 0.22). On-demand CXR was more frequently associated with treatment modification (which would not have occurred without the CXR) than daily routine CXR (38 vs. 19%, P < 0.001): placement/modification/or removal of an invasive device (18 vs. 9%, P < 0.001), prescription of another paraclinical investigation (15 vs. 3%, P < 0.001), initiation/continuation/or discontinuation of medications (25 vs. 11%, P < 0.001). CXR findings were expected and had no impact on management in 56 and 77% (P < 0.001) of the on-demand and daily routine CXR, respectively.

Conclusions

There is an obvious lack of consensus for CXR prescription in French ICUs. The clinical impact of on-demand CXR is higher than that associated with a daily routine prescription.

Authors’ Affiliations

(1)
CHU Lapeyronie, Montpellier, France
(2)
CHU Caremeau, Nimes, France
(3)
CHU Saint Eloi, Montpellier, France

Copyright

© Serveaux-Delous et al. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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