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

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 retrospec...

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Bibliographic Details
Published in:The American journal of surgery 2010-02, Vol.199 (2), p.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: Article
Language:English
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
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Summary: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.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2009.03.011