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Prescription practice and clinical utility of chest radiographs in a pediatric intensive care unit: a prospective observational study

BACKGROUND: Chest radiograph (CXR) prescribing pattern and practice vary widely among pediatric intensive care units (PICU). ‘On demand’ approach is increasingly recommended as against daily ‘routine’ CXRs; however, the real-world practice is largely unknown. METHODS: This was a prospective observat...

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Autores principales: Gupta, Rajeev, Nallasamy, Karthi, Williams, Vijai, Saxena, Akshay Kumar, Jayashree, Muralidharan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941116/
https://www.ncbi.nlm.nih.gov/pubmed/33750327
http://dx.doi.org/10.1186/s12880-021-00576-6
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author Gupta, Rajeev
Nallasamy, Karthi
Williams, Vijai
Saxena, Akshay Kumar
Jayashree, Muralidharan
author_facet Gupta, Rajeev
Nallasamy, Karthi
Williams, Vijai
Saxena, Akshay Kumar
Jayashree, Muralidharan
author_sort Gupta, Rajeev
collection PubMed
description BACKGROUND: Chest radiograph (CXR) prescribing pattern and practice vary widely among pediatric intensive care units (PICU). ‘On demand’ approach is increasingly recommended as against daily ‘routine’ CXRs; however, the real-world practice is largely unknown. METHODS: This was a prospective observational study performed in children younger than 12 years admitted to PICU of a tertiary care teaching hospital in India. Data were collected on all consecutive CXRs performed between December 2016 and April 2017. The primary outcome was to assess the factors that were associated with higher chest radiograph prescriptions in PICU. Secondary outcomes were to study the indications, association with mechanical ventilation, image quality and avoidable radiation exposure. RESULTS: Of 303 children admitted during the study period, 159 underwent a total of 524 CXRs in PICU. Median (IQR) age of the study cohort was 2 (0.6–5) years. More than two thirds [n = 115, 72.3%] were mechanically ventilated. Most CXRs (n = 449, 85.7%) were performed on mechanically ventilated patients, amounting to a median (IQR) of 3 (2–5) radiographs per ventilated patient. With increasing duration of ventilation, the number of CXRs proportionately increased in the first two weeks of mechanical ventilation. In non-ventilated children, about two thirds (68%) underwent only one CXR. Majority of the prescriptions were on demand (n = 461, 88%). Most common indications were peri-procedure prescriptions (37%) followed by evaluation for respiratory disease status (24%). About 40% CXRs resulted in interventions; adjustment in ventilator settings (13.5%) was the most frequent intervention. In 26% (n = 138) of radiographs, image quality required improvement. One or more additional body part exposure other than chest and upper abdomen were noted 336 (64%) images. Children with > 3 CXR had higher PRISM III score, more often mechanically ventilated, had higher number of indwelling devices [mean (SD) 2.6 (1.2) vs. 1.7 (1.0)] and stayed longer in PICU [median (IQR) 11(7.5–18.5) vs. 6 (3–9)]. CONCLUSION: On demand prescription was the prevalent practice in our PICU. Most non-ventilated children underwent only one CXR while duration of PICU stay and the number of devices determined the number of CXRs in mechanically ventilated children. Quality improvement strategies should concentrate on the process of acquisition of images and limiting the radiation exposure to unwanted body parts.
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spelling pubmed-79411162021-03-09 Prescription practice and clinical utility of chest radiographs in a pediatric intensive care unit: a prospective observational study Gupta, Rajeev Nallasamy, Karthi Williams, Vijai Saxena, Akshay Kumar Jayashree, Muralidharan BMC Med Imaging Research BACKGROUND: Chest radiograph (CXR) prescribing pattern and practice vary widely among pediatric intensive care units (PICU). ‘On demand’ approach is increasingly recommended as against daily ‘routine’ CXRs; however, the real-world practice is largely unknown. METHODS: This was a prospective observational study performed in children younger than 12 years admitted to PICU of a tertiary care teaching hospital in India. Data were collected on all consecutive CXRs performed between December 2016 and April 2017. The primary outcome was to assess the factors that were associated with higher chest radiograph prescriptions in PICU. Secondary outcomes were to study the indications, association with mechanical ventilation, image quality and avoidable radiation exposure. RESULTS: Of 303 children admitted during the study period, 159 underwent a total of 524 CXRs in PICU. Median (IQR) age of the study cohort was 2 (0.6–5) years. More than two thirds [n = 115, 72.3%] were mechanically ventilated. Most CXRs (n = 449, 85.7%) were performed on mechanically ventilated patients, amounting to a median (IQR) of 3 (2–5) radiographs per ventilated patient. With increasing duration of ventilation, the number of CXRs proportionately increased in the first two weeks of mechanical ventilation. In non-ventilated children, about two thirds (68%) underwent only one CXR. Majority of the prescriptions were on demand (n = 461, 88%). Most common indications were peri-procedure prescriptions (37%) followed by evaluation for respiratory disease status (24%). About 40% CXRs resulted in interventions; adjustment in ventilator settings (13.5%) was the most frequent intervention. In 26% (n = 138) of radiographs, image quality required improvement. One or more additional body part exposure other than chest and upper abdomen were noted 336 (64%) images. Children with > 3 CXR had higher PRISM III score, more often mechanically ventilated, had higher number of indwelling devices [mean (SD) 2.6 (1.2) vs. 1.7 (1.0)] and stayed longer in PICU [median (IQR) 11(7.5–18.5) vs. 6 (3–9)]. CONCLUSION: On demand prescription was the prevalent practice in our PICU. Most non-ventilated children underwent only one CXR while duration of PICU stay and the number of devices determined the number of CXRs in mechanically ventilated children. Quality improvement strategies should concentrate on the process of acquisition of images and limiting the radiation exposure to unwanted body parts. BioMed Central 2021-03-09 /pmc/articles/PMC7941116/ /pubmed/33750327 http://dx.doi.org/10.1186/s12880-021-00576-6 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Gupta, Rajeev
Nallasamy, Karthi
Williams, Vijai
Saxena, Akshay Kumar
Jayashree, Muralidharan
Prescription practice and clinical utility of chest radiographs in a pediatric intensive care unit: a prospective observational study
title Prescription practice and clinical utility of chest radiographs in a pediatric intensive care unit: a prospective observational study
title_full Prescription practice and clinical utility of chest radiographs in a pediatric intensive care unit: a prospective observational study
title_fullStr Prescription practice and clinical utility of chest radiographs in a pediatric intensive care unit: a prospective observational study
title_full_unstemmed Prescription practice and clinical utility of chest radiographs in a pediatric intensive care unit: a prospective observational study
title_short Prescription practice and clinical utility of chest radiographs in a pediatric intensive care unit: a prospective observational study
title_sort prescription practice and clinical utility of chest radiographs in a pediatric intensive care unit: a prospective observational study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941116/
https://www.ncbi.nlm.nih.gov/pubmed/33750327
http://dx.doi.org/10.1186/s12880-021-00576-6
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