A web-based Delphi study on the indications of chest radiographs for patients in ICUs.
BACKGROUND
Strategies for ordering bedside chest radiographs (CXRs) have substantial logistic and financial consequences in the ICU. Many of the indications for CXRs in the ICU are controversial, such as the ordering of daily routine CXRs for intubated patients. The opinions of intensivists about ordering CXRs have not been reported. Comparing these opinions to established guidelines and identifying situations where opinions diverge in the absence of guidelines are of considerable interest.


METHODS
We asked 190 intensivists from 34 ICUs in the area of Paris, France, to anonymously complete a 29-item questionnaire about their opinions regarding the ordering of CXRs; each item described a clinical scenario. Of the 29 scenarios, 10 dealt with the placement of medical devices, 8 with the presence of medical devices, and 11 with other clinical situations. The study was based on a Delphi process deployed over the Internet through an original software application. Three Delphi rounds were run between January and March 2006, using the same questionnaire. Detailed feedback for the answers given during the previous round was supplied to each intensivist solicited for updating his answers.


RESULTS
Eighty-two intensivists from 32 ICUs completed the study. A consensus emerged that routine CXRs were necessary for eight scenarios and unnecessary for two scenarios. The study also shed light on items without a consensus. In particular, 75% of intensivists (58% on the first round) did not support obtaining daily routine CXRs in intubated patients.


CONCLUSIONS
The study underlines situations in which intensivists do not support the guidelines and outlines recommendations likely to be followed in clinical practice.
Hejblum
Gilles
G
U707, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France. gilles.hejblum@u707.jussieu.fr
Ioos
Vincent
V
Vibert
Jean-François
JF
Böelle
Pierre-Yves
PY
Chalumeau-Lemoine
Ludivine
L
Chouaid
Christos
C
Valleron
Alain-Jacques
AJ
Guidet
Bertrand
B
D016638:Critical Illness / Q000628:therapy; D003697:Delphi Technique; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D020407:Internet; D010297:Paris; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D012121:Respiration, Artificial; D012189:Retrospective Studies