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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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| Published in: | The American journal of surgery 2010-02, Vol.199 (2), p.199-203 |
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| container_end_page | 203 |
| container_issue | 2 |
| container_start_page | 199 |
| container_title | The American journal of surgery |
| container_volume | 199 |
| creator | Goodman, Michael D., M.D Huber, Nathan L., M.D Johannigman, Jay A., M.D Pritts, Timothy A., M.D., Ph.D |
| description | 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. |
| doi_str_mv | 10.1016/j.amjsurg.2009.03.011 |
| format | article |
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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.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2009.03.011</identifier><identifier>PMID: 20113700</identifier><identifier>CODEN: AJSUAB</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>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</subject><ispartof>The American journal of surgery, 2010-02, Vol.199 (2), p.199-203</ispartof><rights>Elsevier Inc.</rights><rights>2010 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright 2010 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Feb 1, 2010</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c477t-a5d98d02aa918d290b0c56d8ba6003294f270352d279571fffc003740d3c64493</citedby><cites>FETCH-LOGICAL-c477t-a5d98d02aa918d290b0c56d8ba6003294f270352d279571fffc003740d3c64493</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>309,310,314,780,784,789,790,23930,23931,25140,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22383913$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20113700$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Goodman, Michael D., M.D</creatorcontrib><creatorcontrib>Huber, Nathan L., M.D</creatorcontrib><creatorcontrib>Johannigman, Jay A., M.D</creatorcontrib><creatorcontrib>Pritts, Timothy A., M.D., Ph.D</creatorcontrib><title>Omission of routine chest x-ray after chest tube removal is safe in selected trauma patients</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>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.</description><subject>Adult</subject><subject>Algorithms</subject><subject>Background radiation</subject><subject>Biological and medical sciences</subject><subject>Chest</subject><subject>Chest tube</subject><subject>Chest tube removal</subject><subject>Chest Tubes - economics</subject><subject>Chest x-ray</subject><subject>Clinical medicine</subject><subject>Cost-Benefit Analysis</subject><subject>Data analysis</subject><subject>Demographics</subject><subject>Device Removal - economics</subject><subject>Female</subject><subject>Gender</subject><subject>General aspects</subject><subject>Hemothorax - diagnostic imaging</subject><subject>Hemothorax - economics</subject><subject>Hemothorax - etiology</subject><subject>Hemothorax - therapy</subject><subject>Hospital Charges</subject><subject>Humans</subject><subject>Injuries</subject><subject>Male</subject><subject>Medical records</subject><subject>Medical sciences</subject><subject>Ohio</subject><subject>Patients</subject><subject>Pneumothorax - diagnostic imaging</subject><subject>Pneumothorax - economics</subject><subject>Pneumothorax - etiology</subject><subject>Pneumothorax - therapy</subject><subject>Radiography</subject><subject>Retrospective Studies</subject><subject>Safety</subject><subject>Secondary Prevention</subject><subject>Studies</subject><subject>Surgery</subject><subject>Thoracic Injuries - complications</subject><subject>Thoracic Injuries - economics</subject><subject>Thoracic Injuries - therapy</subject><subject>Thoracostomy - economics</subject><subject>Thorax</subject><subject>Trauma</subject><subject>Trauma centers</subject><subject>Tube thoracostomy</subject><subject>X-rays</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><recordid>eNqFkkuLFDEQgIMo7jj6E5SAiKduK0l3p3NRZPEFC3tQb0LIJBVN248x6V6cf2-aaV3Yi6dUKl8qVR8h5CmDkgFrXnWlGbq0xO8lB1AliBIYu0d2rJWqYG0r7pMdAPBCNQwuyKOUurxlrBIPyQXPgZAAO_LteggphWmkk6dxWuYwIrU_MM30dxHNiRo_Y9wy83JAGnGYbkxPQ6LJeKRhpAl7tDM6OkezDIYezRxwnNNj8sCbPuGTbd2Tr-_ffbn8WFxdf_h0-faqsJWUc2Fqp1oH3BjFWscVHMDWjWsPpgEQXFWeSxA1d1yqWjLvvc15WYETtqkqJfbk5bnuMU6_ltypzkNZ7Hsz4rQkLUXFm5opnsnnd8huWuKYm9P5uGrrupFNpuozZeOUUkSvjzEMJp40A73a153e7OvVvgahV6N78myrvhwGdP9u_dWdgRcbYJI1vY9mtCHdcly0QjGRuTdnDrO1m4BRJ5uNWnQhZtPaTeG_rby-U8H2YQz50Z94wnQ7tU5cg_68fpX1p4DKQS1b8QefILi3</recordid><startdate>20100201</startdate><enddate>20100201</enddate><creator>Goodman, Michael D., M.D</creator><creator>Huber, Nathan L., M.D</creator><creator>Johannigman, Jay A., M.D</creator><creator>Pritts, Timothy A., M.D., Ph.D</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20100201</creationdate><title>Omission of routine chest x-ray after chest tube removal is safe in selected trauma patients</title><author>Goodman, Michael D., M.D ; Huber, Nathan L., M.D ; Johannigman, Jay A., M.D ; Pritts, Timothy A., M.D., Ph.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c477t-a5d98d02aa918d290b0c56d8ba6003294f270352d279571fffc003740d3c64493</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Algorithms</topic><topic>Background radiation</topic><topic>Biological and medical sciences</topic><topic>Chest</topic><topic>Chest tube</topic><topic>Chest tube removal</topic><topic>Chest Tubes - economics</topic><topic>Chest x-ray</topic><topic>Clinical medicine</topic><topic>Cost-Benefit Analysis</topic><topic>Data analysis</topic><topic>Demographics</topic><topic>Device Removal - economics</topic><topic>Female</topic><topic>Gender</topic><topic>General aspects</topic><topic>Hemothorax - diagnostic imaging</topic><topic>Hemothorax - economics</topic><topic>Hemothorax - etiology</topic><topic>Hemothorax - therapy</topic><topic>Hospital Charges</topic><topic>Humans</topic><topic>Injuries</topic><topic>Male</topic><topic>Medical records</topic><topic>Medical sciences</topic><topic>Ohio</topic><topic>Patients</topic><topic>Pneumothorax - diagnostic imaging</topic><topic>Pneumothorax - economics</topic><topic>Pneumothorax - etiology</topic><topic>Pneumothorax - therapy</topic><topic>Radiography</topic><topic>Retrospective Studies</topic><topic>Safety</topic><topic>Secondary Prevention</topic><topic>Studies</topic><topic>Surgery</topic><topic>Thoracic Injuries - complications</topic><topic>Thoracic Injuries - economics</topic><topic>Thoracic Injuries - therapy</topic><topic>Thoracostomy - economics</topic><topic>Thorax</topic><topic>Trauma</topic><topic>Trauma centers</topic><topic>Tube thoracostomy</topic><topic>X-rays</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Goodman, Michael D., M.D</creatorcontrib><creatorcontrib>Huber, Nathan L., M.D</creatorcontrib><creatorcontrib>Johannigman, Jay A., M.D</creatorcontrib><creatorcontrib>Pritts, Timothy A., M.D., Ph.D</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Goodman, Michael D., M.D</au><au>Huber, Nathan L., M.D</au><au>Johannigman, Jay A., M.D</au><au>Pritts, Timothy A., M.D., Ph.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Omission of routine chest x-ray after chest tube removal is safe in selected trauma patients</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2010-02-01</date><risdate>2010</risdate><volume>199</volume><issue>2</issue><spage>199</spage><epage>203</epage><pages>199-203</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><coden>AJSUAB</coden><abstract>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.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>20113700</pmid><doi>10.1016/j.amjsurg.2009.03.011</doi><tpages>5</tpages></addata></record> |
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| 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 |
| title | Omission of routine chest x-ray after chest tube removal is safe in selected trauma patients |
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