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Erschienen in:
27.10.2017 | Chest
Radiation protection: Factors influencing compliance to referral guidelines in minor chest trauma
Erschienen in: European Radiology | Ausgabe 4/2018
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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.