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

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.

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Correspondence to MS Serveaux-Delous.

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Serveaux-Delous, M., Lakhal, K., Capdevila, X. et al. Prescription and clinical impact of chest radiographs in 104 French ICUs: the RadioDay Study. Crit Care 15, P137 (2011). https://doi.org/10.1186/cc9557

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Keywords

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