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A WEB-BASED DELPHI STUDY ON THE INDICATIONS OF CHEST RADIOGRAPHS FOR PATIENTS IN INTENSIVE CARE UNITS

¹INSERM, U707, Paris, F-75012 France ²Université Pierre et Marie Curie-Paris6, UMR S 707, Paris, F-75012 France ³AP-HP, Hôpital Saint Antoine, Unité de Santé Publique, Paris, F-75012 France ⁴AP-HP, Hôpital Saint Antoine, Service de Réanimation, Paris, F-75012 France ⁵AP-HP, Hôpital Saint Antoine, Service de Physiologie, Paris, F-75012 France ⁶AP-HP, Hôpital Saint Antoine, Service de Pneumologie, Paris, F-75012 France

gilles.hejblum{at}u707.jussieu.fr

Abstract

BackgroundStrategies for ordering bedside chest X-rays (CXRs) have substantial logistic and financial consequences in intensive care units (ICUs). Many of the indications for CXRs in the ICU are controversial, such as daily routine CXRs for intubated patients. 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.

MethodsWe asked 190 intensivists from 34 ICUs in the Paris area, France, to anonymously complete a 29-item questionnaire about their opinions regarding CXR ordering; each item described a clinical scenario. Of the 29 scenarios, 10 dealt with placement of medical devices, 8 with 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. A detailed feedback of the answers at the previous round was supplied to each intensivist solicited for updating his answers.

Results82 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 made also emerge items where consensus is not attained. In particular, 75% of intensivists (58% at the first round) did not support daily routine CXR in intubated patients.

ConclusionThe study underlines situations where intensivists do not support guidelines and outlines recommendations likely to be followed in clinical practice.

Key Words: Radiography • Thoracic • Delphi Technique • Intensive Care Units • Ventilation • mechanical • Information Science

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From Delphi to Knowledge and Comfort: The Devil Is in the Details

Klaus-Dieter Lessnau
Chest 2008 133: 1060-1062. [Full Text] [PDF]

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				K.-D. Lessnau From Delphi to Knowledge and Comfort: The Devil Is in the Details Chest, May 1, 2008; 133(5): 1060 - 1062. [Full Text] [PDF]