title: On-demand rather than daily-routine chest radiography prescription may change neither the number nor the impact of chest computed tomography and ultrasound studies in a multidisciplinary intensive care unit.
abstract: BACKGROUND
  Elimination of daily-routine chest radiographs (CXRs) may influence chest computed tomography (CT) and ultrasound practice in critically ill patients.
  
  
  METHODS
  This was a retrospective cohort study including all patients admitted to a university-affiliated intensive care unit during two consecutive periods of 5 months, one before and one after elimination of daily-routine CXR. Chest CT and ultrasound studies were identified retrospectively by using the radiology department information system. Indications for and the diagnostic/therapeutic yield of chest CT and ultrasound studies were collected.
  
  
  RESULTS
  Elimination of daily-routine CXR resulted in a decrease of CXRs per patient day from 1.1 +/- 0.3 to 0.6 +/- 0.4 (P < 0.05). Elimination did not affect duration of stay or mortality rates. Neither the number of chest CT studies nor the ratio of chest CT studies per patient day changed with the intervention: Before elimination of daily-routine CXR, 52 chest CT studies were obtained from 747 patients; after elimination, 54 CT studies were obtained from 743 patients. Similarly, chest ultrasound practice was not affected by the change of CXR strategy: Before and after elimination, 21 and 27 chest ultrasound studies were performed, respectively. Also, timing of chest CT and ultrasound studies was not different between the two study periods. During the two periods, 40 of 106 chest CT studies (38%) and 18 of 48 chest ultrasound studies (38%) resulted in a change in therapy. The combined therapeutic yield of chest CT and ultrasound studies did not change with elimination of daily-routine CXR.
  
  
  CONCLUSIONS
  Elimination of daily-routine CXRs may not affect chest CT and ultrasound practice in a multidisciplinary intensive care unit.
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. ankekroner@gmail.com
authors.forename: Anke
authors.initials: A
authors.lastname: Kröner
authors.forename: Jan M
authors.initials: JM
authors.lastname: Binnekade
authors.forename: Marleen E
authors.initials: ME
authors.lastname: Graat
authors.forename: Margreeth B
authors.initials: MB
authors.lastname: Vroom
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.forename: Peter E
authors.initials: PE
authors.lastname: Spronk
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000639:trends; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000639:trends; D008297:Male; D008875:Middle Aged; D055656:Prescriptions; D013902:Radiography, Thoracic / Q000379:methods / Q000639:trends; D012189:Retrospective Studies; D013909:Thorax / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000639:trends; D014463:Ultrasonography