Retrospective review of the use and costs of routine chest x rays in a trauma setting

Ziegler, Kristina; Feeney, James M.; Desai, Colleen; Sharpio, David; Marshall, William T.; Twohig, Michael

doi:10.1186/1752-2897-7-2

Cited by 20 publications

(20 citation statements)

References 22 publications

(22 reference statements)

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“…Five activities were identified to determine the estimated cost. These included human resources, capital, consumables, energy cost, and radiologist fee for study interpretation [6][7][8] (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

“…Medical facilities need to calculate utilizing their ABCA estimation to determine facility-based cost for a single chest radiograph. [6][7][8] In particular, smaller facilities where chest radiographs are part of a radiology business model and could have a higher effect. From a purely financial perspective this may affect net revenue.…”

Section: Financial Considerationsmentioning

confidence: 99%

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Dual Vector Biosensor Catheter Tip Positioning System: A 3-Year Retrospective Analysis

Ramirez

Roy

Foster

2015

Journal of the Association for Vascular Access

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Background: Vascular access is continually evolving in areas of clinical practice and new technology. Our vascular access team (VAT), like many others, has moved away from chest radiograph after peripherally inserted central catheter (PICC) insertion to a catheter tip positioning system or tip locating device (TLD). Our VAT collected data over a 3-year period to assess any changes that resulted from the TLD implementation. The intent was to drill down into the PICC data over the 3 years and quantify any changes gained or lost from the previous practice of post-PICC insertion chest radiograph. Methods: A share point database system that was already in place was updated to also incorporate key elements of the TLD. Initial time studies were also collected to validate average cycle time. The VAT was educated and validated on the TLD technology before implementation. Key stakeholders (ie, members of the radiology department, administration, hospitalist physicians, and the medical director) were communicated with and signed off on the project. Results: Retrospective analysis from 2012-2014 revealed that 1079 PICCs had been inserted. Of those, 781 PICCs were placed successfully with the TLD with an accompanying reduction of 781 chest radiographs. Precycle time averaged 114 minutes compared with post-TLD, which averaged 37 minutes. No changes in deep vein thrombosis rate were identified. Conclusions: Implementing the dual vector biosensor TLD improved our insertion cycle time by a mean of 77 minutes. The new cycle time provided increased procedure capacity for the VAT. Chest radiograph reduction of 72% was also realized with the TLD over the 3-year period.

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Section: Discussionmentioning

confidence: 99%

Section: Financial Considerationsmentioning

confidence: 99%

Dual Vector Biosensor Catheter Tip Positioning System: A 3-Year Retrospective Analysis

Ramirez

Roy

Foster

2015

Journal of the Association for Vascular Access

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“…Others studies reported the sensitivities of 29% [10] and 14.3% [9] in detecting pneumothorax. In the present study, the sensitivity of CXR was 55.3% and 33% in detecting rib fractures and pneumothoraces respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Studies reported sensitivities of 25.5% [8] and 39.4% [9] for CXR in detecting rib fractures in patients with blunt chest trauma. Others studies reported the sensitivities of 29% [10] and 14.3% [9] in detecting pneumothorax.…”

Section: Discussionmentioning

confidence: 99%

Chest X-rays in detecting injuries caused by blunt trauma

Ağladıoğlu¹,

Serinken²,

Dal³

et al. 2016

World Journal of Emergency Medicine

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BACKGROUND:The appropriate sequence of different imagings and indications of thoracic computed tomography (TCT) in evaluating chest trauma have not yet been clarifi ed at present. The current study was undertaken to determine the value of chest X-ray (CXR) in detecting chest injuries in patients with blunt trauma. METHODS:A total of 447 patients with blunt thoracic trauma who had been admitted to the emergency department (ED) in the period of 2009-2013 were retrospectively reviewed. The patients met inclusion criteria (age>8 years, blunt injury to the chest, hemodynamically stable, and neurologically intact) and underwent both TCT and upright CXR in the ED. Radiological imagings were re-interpreted after they were collected from the hospital database by two skilled radiologists. RESULTS:Of the 447 patients, 309 (69.1%) were male. The mean age of the 447 patients was 39.5±19.2 (range 9 and 87 years). 158 (35.3%) patients were injured in motor vehicle accidents (MVA). CXR showed the highest sensitivity in detecting clavicle fractures ] but the lowest in pneuomediastinum ]. The specifi city of CXR was close to 100% in detecting a wide array of entities.CONCLUSION: CXR remains to be the fi rst choice in hemodynamically unstable patients with blunt chest trauma. Moreover, stable patients with normal CXR are candidates who should undergo TCT if signifi cant injury has not been ruled out.

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“…20 Median charges for chest x-ray in 2013 are $298 per examination, while median charges for chest CT are $3,294 per patient. 13,21 Potential risks include harmful effects from ionizing radiation exposure, as well as potential renal injury and allergic reactions from intravenous contrast. 22 While CXR delivers negligible amounts of radiation, chest CT exposes the patient to a considerable effective radiation dose (ERD) and cancer induction risk, especially for women.…”

Section: Introductionmentioning

confidence: 99%

Selective chest imaging for blunt trauma patients: The national emergency X-ray utilization studies (NEXUS-chest algorithm)

Rodriguez

Hendey²,

Mower

2017

The American Journal of Emergency Medicine

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Chest imaging plays a prominent role in blunt trauma patient evaluation, but indiscriminate imaging is expensive, may delay care, and unnecessarily exposes patients to potentially harmful ionizing radiation. To improve diagnostic chest imaging utilization, we conducted 3 prospective multicenter studies over 12 years to derive and validate decision instruments (DIs) to guide the use of chest x-ray (CXR) and chest computed tomography (CT). The first DI, NEXUS Chest x-ray, consists of seven criteria (Age > 60 years; rapid deceleration mechanism; chest pain; intoxication; altered mental status; distracting painful injury; and chest wall tenderness) and exhibits a sensitivity of 99.0% (95% confidence interval [CI] 98.2-99.4%) and a specificity of 13.3% (95% CI, 12.6%-14.0%) for detecting clinically significant injuries. We developed two NEXUS Chest CT DIs, which are both highly reliable in detecting clinically major injuries (sensitivity of 99.2%; 95% CI 95.4-100%). Designed primarily to focus on detecting major injuries, the NEXUS Chest CT-Major DI consists of six criteria (abnormal CXR; distracting injury; chest wall tenderness; sternal tenderness; thoracic spine tenderness; and scapular tenderness) and exhibits higher specificity (37.9%; 95% CI 35.8–40.1%). Designed to reliability detect both major and minor injuries (sensitivity 95.4%; 95% CI 93.6–96.9%) with resulting lower specificity (25.5%; 95% CI 23.5–27.5%), the NEXUS CT-All rule consists of seven elements (the six NEXUS CT-Major criteria plus rapid deceleration mechanism). The purpose of this review is to synthesize the three DIs into a novel, cohesive summary algorithm with practical implementation recommendations to guide selective chest imaging in adult blunt trauma patients.

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Retrospective review of the use and costs of routine chest x rays in a trauma setting

Cited by 20 publications

References 22 publications

Dual Vector Biosensor Catheter Tip Positioning System: A 3-Year Retrospective Analysis

Dual Vector Biosensor Catheter Tip Positioning System: A 3-Year Retrospective Analysis

Chest X-rays in detecting injuries caused by blunt trauma

Selective chest imaging for blunt trauma patients: The national emergency X-ray utilization studies (NEXUS-chest algorithm)

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