Is routine chest radiograph necessary after chest tube removal?
Document Type
Article
Publication Date
10-1-2014
Identifier
DOI: 10.1016/j.jpedsurg.2014.01.004
Abstract
Background: Obtaining a chest radiograph (CXR) after chest tube (CT) removal to rule out a pneumothorax is a universal practice. However, the yield of this CXR has not been well documented. Additionally, most iatrogenic pneumothoraces resulting from CT removal are atmospheric in origin, asymptomatic, and can be observed. Recently, we have begun to discontinue routine CXR for CT removal. We evaluated our experience with CT removal to clarify the usefulness of routine post CT removal CXR.
Methods: After IRB approval, a retrospective study was conducted on patients who had a CT placed in the past decade. Cardiac patients requiring a CT were excluded. Patient demographics, diagnosis, treatments, and outcomes were collected. Patients were divided into two groups, those with a CXR after CT removal (Group 1) and those without (Group 2). Percentages were compared with Chi square with Yates correction.
Results: 462 patients were identified (group 1=327, group 2=135). Indications for CT included; empyema (n=176), lung resection (n=146), pneumothorax (n=71), pleural effusion (n=26), spinal fusion (n=20), trauma (n=16), and miscellaneous (n=7). Seven patients (2.1%) in group 1 required reinsertion for pneumothorax (n=4), empyema (n=2), and pleural effusion (n=1) compared to 1 patient (0.7%) in group 2 who required reinsertion for pleural effusion. This difference was not significant (P=0.2).
Conclusions: In non-cardiac patients with a CT, tube reinsertion is uncommon and tube replacement is secondary to symptoms. Therefore, routine post CT removal CXR is not necessary. CXR in these patients should be obtained based upon clinical indications after CT removal.
Journal Title
Journal of pediatric surgery
Volume
49
Issue
10
First Page
1493
Last Page
1495
MeSH Keywords
Adolescent; Chest Tubes; Child; Device Removal; Female; Humans; Male; Pneumothorax; Radiography, Thoracic; Respiratory Tract Diseases; Retrospective Studies; Thoracostomy
Keywords
Chest x-ray; Chest Tube; Children
Recommended Citation
Cunningham, J. P., Knott, E. M., Gasior, A. C., Juang, D., Snyder, C. L., St Peter, S. D., Ostlie, D. J. Is routine chest radiograph necessary after chest tube removal? Journal of pediatric surgery 49, 1493-1495 (2014).
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