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Original Research: CRITICAL CARE MEDICINE |

A Web-Based Delphi Study on the Indications of Chest Radiographs for Patients in ICUs*

Gilles Hejblum, PhD; Vincent Ioos, MD; Jean-François Vibert, MD; Pierre-Yves Böelle, PhD; Ludivine Chalumeau-Lemoine, MD; Christos Chouaid, MD; Alain-Jacques Valleron, PhD; Bertrand Guidet, MD
Author and Funding Information

*From U707 (Dr. Hejblum), Institut National de la Santé et de la Recherche Médicale; Service de Réanimation (Drs. Ioos and Chalumeau-Lemoine), Service de Physiologie (Dr. Vibert), Unité de Santé Publique (Drs. Böelle and Valleron), and Service de Pneumologie (Dr. Chouaid), Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris; and UMR S707 (Dr. Guidet), Université Pierre et Marie Curie-Paris6, Paris, France.

Correspondence to: Gilles Hejblum, PhD, INSERM U707/Unité de Santé Publique, Bâtiment Caroli, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France; e-mail: gilles.hejblum@u707.jussieu.fr



Chest. 2008;133(5):1107-1112. doi:10.1378/chest.06-3014
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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.

Conclusion: The study underlines situations in which intensivists do not support the guidelines and outlines recommendations likely to be followed in clinical practice.


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