Adecuación de la petición de radiografías de tórax en urgencias hospitalarias

Abstract

ObjectiveTo describe the use of chest radiography in the general emergency department of La Paz University Hospital, based on evidence-based guidelines to evaluate the degree of appropriateness of this test, and to identify the clinical factors associated with greater inappropriate use. Material and MethodsWe performed a descriptive, analytical study (univariate and multivariate) of patients presenting to the general emergency department in the week of 18-24 February 2002 who underwent chest radiography. The appropriateness of this test was evaluated according to reviewed standards (main variable: appropriateness or inappropriateness). To do this, a systematic review of evidence-based guidelines and protocols on the indication for chest radiography was performed and a data sheet was created, based on the most important articles. ResultsEighty-four percent of the requested chest radiographies reviewed were appropriate according to the selected criteria; the remaining tests (16%) were inappropriate according to these criteria. The clinical factors associated with greater inappropriate use were: costal mechanical pain after minor thoracic injury (31.4%), nonspecific symptoms (general feeling of discomfort, fever…) (27.5%), nonspecific abdominal pain (23.5%) and mechanical thoracic pain (17.6%).The age-adjusted risk of inappropriate use was 2.35 times higher at the weekend than during the rest of the week (95% CI, 1.24-4.45, p = 0.008). Adjusting by day of request (weekend versus non weekend), with each year of decreased age, the risk of inappropriate use increased by 1.02-fold (95% CI, 1.01-1.04; p < 0.001). ConclusionsSixteen percent of requests for chest radiography were deemed inappropriate, which represents an opportunity for improvement (health care quality and optimization of resource use). Inappropriate use is greater in the youngest patients, who are more demanding, which could lead to a greater number of unnecessary tests.The greater percentage of inappropriate use at the weekends could indicate insufficient supervision of duty physicians by experienced physicians or a reluctance on the part of residents to seek advice from supervisors.