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

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 Radio-Day, 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 "ondemand" 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 "ondemand" 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. © Copyright jointly held by Springer and ESICM 2012.