Chest x-rays overused on ventilation patients despite ACR guidelines
Despite 2011 guidelines from the American College of Radiology (AVR) that recommend against chest x-rays (CXRs) for patients requiring mechanical ventilation, at least 60 percent of these patients receive daily CXRs in American hospitals, according to research published online Aug. 10 in JAMA Network Open.
Reseaerchers—led by Hayley Gershengorn, MD, of the Leonard M. Miller School of Medicine at the University of Miami—found that the hospital that delivered mechanical ventilation to a patient is the primary largest determining factor in the daily use of CXRs.
While daily CXR rates decreased from 2008 to 2014, the overall findings were both “concerning and encouraging," the researchers explained.
“This [study] provides a key insight for targeting de-adoption of this practice, suggesting that efforts should be made at understanding and intervening at the institutional level,” Gershengorn et al. wrote. “Moreover, the remaining widespread use means there are likely some high-use hospitals in which simple interventions could dramatically affect practice—institutions in which attempts at change might represent low-hanging fruit.”
For their study, Gershengorn and colleagues analyzed patient data in the Premier Perspectives database from 512, 518 adults who received mechanical ventilation for at least three days and were discharged from July 1, 2008, through Dec. 31, 2014.
In total, 63 percent received daily CXRs every day up to seven days after mechanical ventilation initiation, according to the researchers. They also noted wide variability across all hospitals, with some performing daily CXRs on up to 97 percent of patients.
“The odds of receiving a daily chest radiograph were 2.43-fold higher if the same patient was discharged from a higher- versus lower-use hospital and, starting in the fourth quarter of 2011, there was a 3 percent relative reduction in the odds of daily use per quarter through 2014,” the researchers wrote.
A recent graduate from Dominican University (IL) with a bachelor’s in journalism, Melissa joined TriMed’s Chicago team in 2017 covering all aspects of health imaging. She’s a fan of singing and playing guitar, elephants, a good cup of tea, and her golden retriever Cooper.