Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, United States; Division of Emergency Medicine, Department of Surgery, University of Utah, Salt Lake City, UT, United States.
Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States.
J Crit Care. 2018 Apr;44:18-23. doi: 10.1016/j.jcrc.2017.10.003. Epub 2017 Oct 5.
Studies suggest that "on-demand" radiography is equivalent to daily routine with regard to adverse events. In these studies, provider behavior is controlled. Pragmatic implementation has not been studied.
This was a quasi-experimental, pre-post intervention study. Medical directors of two intervention ICUs requested pCXRs be ordered on an on-demand basis at one time point, without controlling or monitoring behavior or providing follow-up.
A total of 11,994 patient days over 18months were included. Combined characteristics: Age: 56.7, 66% male, 96% survival, APACHE II 14 (IQR: 11-19), mechanical ventilation (MV) (occurrences)/patient admission: mean 0.7 (SD: 0.6; range: 0-5), duration (hours) of MV: 21.7 (IQR: 9.8-81.4) and ICU LOS (days): 2.8 (IQR: 1.8-5.6). Average pCXR rate/patient/day before was 0.93 (95% CI: 0.89-0.96), and 0.73 (95% CI: 0.69-0.77) after. Controlling for severity, daily pCXR rate decreased by 21.7% (p<0.001), then increased by about 3%/month (p=0.044). There was no change in APACHE II, mortality, and occurrences or duration of MV, unplanned re-intubations, ICU LOS.
In critically ill adults, pCXR reduction can be achieved in cardiothoracic and trauma/surgical patients with a pragmatic intervention, without adversely affecting patient care, outside a controlled study.
研究表明，“按需”放射学在不良事件方面与日常例行检查相当。在这些研究中，医生的行为受到了控制。但尚未对实用的执行情况进行研究。
这是一项准实验性、干预前后研究。在一个时间点，两个干预性重症监护病房（ICU）的医疗主任要求按需进行床边 X 线摄影，而不控制或监测行为或提供后续服务。
共纳入 18 个月内的 11994 个患者日。综合特征：年龄：56.7 岁，66%为男性，96%存活，急性生理学与慢性健康状况评分系统 II（APACHE II）为 14 分（四分位距：11-19），机械通气（MV）（发生次数）/患者入院：平均值为 0.7（标准差：0.6；范围：0-5），MV 持续时间（小时）：21.7（四分位距：9.8-81.4）和 ICU 住院时间（天）：2.8（四分位距：1.8-5.6）。之前，患者每天的床边 X 线摄影率为 0.93（95%可信区间：0.89-0.96），之后为 0.73（95%可信区间：0.69-0.77）。在控制严重程度后，每天床边 X 线摄影率下降了 21.7%（p<0.001），然后每月增加约 3%（p=0.044）。APACHE II 评分、死亡率以及 MV、计划性再插管、ICU 住院时间的发生次数或持续时间均无变化。
在重症成人患者中，在不进行控制研究的情况下，通过实用的干预措施，可在心胸和创伤/外科患者中实现床边 X 线摄影的减少，而不会对患者护理产生不利影响。
