The utilization of directed clinical evaluation to eliminate routine daily chest X-rays in intensive care unit patients 1 1Funded as a quality improvement tool through the Department of Surgery, Walter Reed Army Medical Center. The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army of the Department of Defense

Autor: Mary E. Maniscalco-Theberge, Gary D. Fleischer, David P. Jaques, Douglas A. Hale, Matthew L. Brengman
Rok vydání: 1999
Předmět:
Zdroj: Current Surgery. 56:441-444
ISSN: 0149-7944
DOI: 10.1016/s0149-7944(99)00159-2
Popis: Purpose T his study was designed to determine whether a directed clinical evaluation could eliminate the need for routine daily chest X-rays (CXRs) in surgical intensive care unit patients. Methods All patients admitted to a 10-bed surgical intensive care unit in a university-affiliated medical center were eligible for evaluation. Patients were evaluated using a 20-point Clinical Evaluation Score (CES) prior to their routine daily CXRs. An evaluation was deemed positive if any parameter was scored as positive. Major CXR findings requiring intervention and minor CXR findings representing changes but not mandating intervention were recorded. Descriptive statistics were used to relate the CES to the CXR findings. Results Fifty-one patients had 216 CESs and CXRs compared. There were 77 positive CESs (36%) and 139 negative CESs (64%). A positive CES predicted 31 of 33 major CXR findings. For major CXR findings requiring intervention, CES had a sensitivity of 94% and a negative predictive value of 98%. Conclusions By utilizing a structured clinical evaluation to determine the need for a morning CXR in this study, we could have eliminated 64% of routine morning CXRs.
Databáze: OpenAIRE
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