Omission of routine chest x-ray after chest tube removal is safe in selected trauma patients

• Published in: The American journal of surgery Vol. 199; no. 2; pp. 199 - 203
• Main Authors: Goodman, Michael D., M.D, Huber, Nathan L., M.D, Johannigman, Jay A., M.D, Pritts, Timothy A., M.D., Ph.D
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2010; Elsevier; Elsevier Limited
• Subjects: Adult; Algorithms; Background radiation; Biological and medical sciences; Chest; Chest tube; Chest tube removal; Chest Tubes - economics; Chest x-ray; Clinical medicine; Cost-Benefit Analysis; Data analysis; Demographics; Device Removal - economics; Female; Gender; General aspects; Hemothorax - diagnostic imaging; Hemothorax - economics; Hemothorax - etiology; Hemothorax - therapy; Hospital Charges; Humans; Injuries; Male; Medical records; Medical sciences; Ohio; Patients; Pneumothorax - diagnostic imaging; Pneumothorax - economics; Pneumothorax - etiology; Pneumothorax - therapy; Radiography; Retrospective Studies; Safety; Secondary Prevention; Studies; Surgery; Thoracic Injuries - complications; Thoracic Injuries - economics; Thoracic Injuries - therapy; Thoracostomy - economics; Thorax; Trauma; Trauma centers; Tube thoracostomy; X-rays; Chest x-ray; Tube thoracostomy; Chest tube removal; Chest tube; Removal; Human; X ray tube; Radiodiagnosis; Exploration; Routine analysis; Patient; Thorax; Thoracotomy; Ablation; Trauma; Medicine; Radiography; Treatment; Surgery
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2009.03.011

Abstract Background Definitive practice guidelines regarding the utility of chest x-ray (CXR) following chest tube removal in trauma patients have not been established. The authors hypothesized that the selective use of CXR following chest tube removal is safe and cost effective. Methods A retrospective review of chest tube insertions performed at a level I trauma center was conducted. Results Patients who underwent chest tube removal without subsequent CXR had a lower mean Injury Severity Score and were less likely to have suffered penetrating thoracic injuries. These patients received fewer total CXRs and had shorter durations of chest tube therapy and shorter lengths of stay following tube removal. Subsequent reinterventions were performed more frequently in the CXR group. The annual decrease in hospital charges by foregoing a CXR was $16,280. Conclusions The selective omission of CXR following chest tube removal in less severely injured, nonventilated patients does not adversely affect outcomes or increase reintervention rates. Avoiding unnecessary routine CXR after chest tube removal could provide a significant reduction in total hospital charges.