Significant changes in the practice of chest radiography in Dutch intensive care units: a web-based survey

Abstract

BackgroundICU patients frequently undergo chest radiographs (CXRs). The diagnostic and therapeutic efficacy of routine CXRs are now known to be low, but the discussion regarding specific indications for CXRs in critically ill patients and the safety of abandoning routine CXRs is still ongoing. We performed a survey of Dutch intensivists on the current practice of chest radiography in their departments.MethodsWeb-based questionnaires, containing questions regarding ICU characteristics, ICU patients, daily CXR strategies, indications for routine CXRs and the practice of radiologic evaluation, were sent to the medical directors of all adult ICUs in the Netherlands. CXR strategies were compared between all academic and non-academic hospitals and between ICUs of different sizes. A comparison was made between the survey results obtained in 2006 and 2013.ResultsOf the 83 ICUs that were contacted, 69 (83%) responded to the survey. Only 7% of responding ICUs were currently performing daily routine CXRs for all patients, and 61% of the responding ICUs were said never to perform CXRs on a routine basis. A daily meeting with a radiologist is an established practice in 72% of the responding ICUs and is judged to be important or even essential by those ICUs. The therapeutic efficacy of routine CXRs was assumed by intensivists to be lower than 10% or to be between 10 and 20%. The efficacy of ‘on-demand’ CXRs was assumed to be between 10 and 60%. There is a consensus between intensivists to perform a routine CXR after endotracheal intubation, chest tube placement or central venous catheterization.ConclusionThe strategy of daily routine CXRs for critically ill and mechanically ventilated patients has turned from being a common practice in 2006 to a rare current practice. Other routine strategies and an ‘on-demand only’ strategy have become more popular. Intensivists still assume the value of CXRs to be higher than the efficacy that is reported in the literature.

Defining indications for selective chest radiography in the first 24 hours after cardiac surgery

“…[29][30][31][32] Despite these findings, our recent web survey of Dutch intensivists revealed that the strategy of daily routine CXRs is a rare practice nowadays, with the exception of routine CXRs for postoperative cardiac surgery patients. 33 Abandoning routine CXRs after cardiac surgery may be safe only when patients at risk are identified and certain indications for CXRs are stated.…”

Prescription practice and clinical utility of chest radiographs in a pediatric intensive care unit: a prospective observational study

“…Secondly, the prevalence of ‘on-demand’ prescription (88%) could be another reason for the lower frequency of CXR prescription in admitted patients. Several centres have reported a change in practice from routine CXRs to on-demand prescriptions over the past two decades [ 13 – 15 ] Although a prospective study conducted in multi-institutional PICUs suggested routine CXRs to be useful in a cohort of critically ill children, subsequent randomized controlled trials in adults and consensus opinions strongly supported the adoption of on-demand strategy to minimize the use of radiography in mechanically ventilated patients without compromising quality of care or safety [ 3 , 17 ].…”

“…The Choosing Wisely campaign (2012) recommended not to use diagnostic tests including CXR on daily basis as they added no benefit to patient care besides increasing cost and potential harm [ 9 – 11 ]. Currently, though most intensivists prefer an on-demand strategy, a wide variation in practice has been reported across hospitals caring for adults and at some places, the daily routine CXR is still common [ 12 – 15 ].…”

Trends in Use of Daily Chest Radiographs Among US Adults Receiving Mechanical Ventilation

“…Two surveys from Dutch ICUs in 2005 and 2013 with different response rates found a decrease from 63% to 7% of ICUs reporting the use of routine daily CXRs. 26 , 27 To our knowledge, there are no studies of practice in the United States to evaluate the use of routine daily CXRs.…”