title: 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.
  
  
  METHODS
  Prospective snapshot observational study (on RadioDay) combined with a survey.
  
  
  METHODS
  Patients who were given a CXR on RadioDay.
  
  
  METHODS
  One hundred four French intensive care units (ICUs).
  
  
  RESULTS
  On RadioDay, 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 "on-demand" 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 PaO(2)/FiO(2) ratio), it is noteworthy that the clinical value of "on-demand" individual CXRs was still markedly higher than that of "daily routine" CXRs.
  
  
  CONCLUSIONS
  Nearly two-thirds of the participating ICUs adopted the "on-demand" 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.
authors.affiliation: Réanimation Polyvalente, Service d'Anesthésie-Réanimation Lapeyronie, Centre Hospitalier Universitaire Lapeyronie, Montpellier, France. lakhal_karim@yahoo.fr
authors.forename: Karim
authors.initials: K
authors.lastname: Lakhal
authors.forename: Marianne
authors.initials: M
authors.lastname: Serveaux-Delous
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Lefrant
authors.forename: Xavier
authors.initials: X
authors.lastname: Capdevila
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D006300:Health Services Misuse / Q000517:prevention & control*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D012121:Respiration, Artificial