Denis Tack1,2, Fabian Louagé3, Alain Van Muylem4, Nigel Howarth5, Pierre Alain Gevenois6. 1. Department of Radiology, Clinique Louis Caty - Hôpital Epicura, Rue Louis Caty 136, 7331, Baudour, Belgium. denis.tack@skynet.be. 2. Department of Radiology, Hôpital Vésale - CHU de Charleroi, Route de Gozée 706, 6110, Montigny-le-Tilleul, Belgium. denis.tack@skynet.be. 3. School of Medicine, Université Libre de Bruxelles, Route de Lennik 808, 1070, Bruxelles, Belgium. 4. Department of Respiratory Medicine, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Bruxelles, Belgium. 5. Department of Radiology, Clinique des Grangettes, Chemin des Grangettes 7, 1224, Chêne-Bougeries, Switzerland. 6. Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Bruxelles, Belgium.
Abstract
OBJECTIVES: To test the hypothesis that referral guidelines are not sufficiently known by prescribers and that medico-legal concerns could influence the prescription of radiographs in minor chest trauma. METHODS: We submitted a questionnaire including a typical clinical history and questions on reasons for prescribing radiographs of the ribs in minor chest trauma to 112 prescriptors (33 residents, 18 surgeons, 7 internists, 24 general practitioners and 30 ER physicians). All accepted to participate. Comparisons were performed by Fisher's exact test followed by a post-hoc analysis and by a McNemar test. RESULTS: Fifty-eight percent of prescriptors proposed rib radiographs, most (89%) being unaware of the guidelines. Only 11% of them changed their intention to order radiographs after information on referral guidelines and radiation dose (P=0.057). The mean dose delivered by rib radiographs was 38 times higher than that of a chest X-ray. Legal and medico-legal concerns (requirements from insurance policies and avoidance of lawsuits) were the main reasons for requesting radiographs. CONCLUSION: Unsharpness of guidelines in addition to social and medico-legal issues, rather than medical reasons or the lack of knowledge of the guidelines, strongly influence the prescription of radiographs of the ribs in minor chest trauma. KEY POINTS: • Most prescriptors order radiographs of the ribs in minor chest trauma. • Only few prescriptors are aware of referral guidelines. • Information on guidelines does not change their need for radiographs. • Motivations for ordering radiographs are rather legal than medical, but poor compliance to guidelines could also be explained by their unsharpness. • Radiation dose of rib radiographs was 38 times that of a PA chest radiograph.
OBJECTIVES: To test the hypothesis that referral guidelines are not sufficiently known by prescribers and that medico-legal concerns could influence the prescription of radiographs in minor chest trauma. METHODS: We submitted a questionnaire including a typical clinical history and questions on reasons for prescribing radiographs of the ribs in minor chest trauma to 112 prescriptors (33 residents, 18 surgeons, 7 internists, 24 general practitioners and 30 ER physicians). All accepted to participate. Comparisons were performed by Fisher's exact test followed by a post-hoc analysis and by a McNemar test. RESULTS: Fifty-eight percent of prescriptors proposed rib radiographs, most (89%) being unaware of the guidelines. Only 11% of them changed their intention to order radiographs after information on referral guidelines and radiation dose (P=0.057). The mean dose delivered by rib radiographs was 38 times higher than that of a chest X-ray. Legal and medico-legal concerns (requirements from insurance policies and avoidance of lawsuits) were the main reasons for requesting radiographs. CONCLUSION: Unsharpness of guidelines in addition to social and medico-legal issues, rather than medical reasons or the lack of knowledge of the guidelines, strongly influence the prescription of radiographs of the ribs in minor chest trauma. KEY POINTS: • Most prescriptors order radiographs of the ribs in minor chest trauma. • Only few prescriptors are aware of referral guidelines. • Information on guidelines does not change their need for radiographs. • Motivations for ordering radiographs are rather legal than medical, but poor compliance to guidelines could also be explained by their unsharpness. • Radiation dose of rib radiographs was 38 times that of a PA chest radiograph.
Authors: Francesco Macri; Joel Greffier; Fabricio Pereira; Alina Chica Rosa; Elina Khasanova; Pierre-Geraut Claret; Ahmed Larbi; Gianfranco Gualdi; Jean Paul Beregi Journal: Eur J Radiol Date: 2016-07-01 Impact factor: 3.528