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

Goodman, Michael D.; Huber, Nathan L.; Johannigman, Jay A.; Pritts, Timothy A.

doi:10.1016/j.amjsurg.2009.03.011

« Previous Next »The American Journal of Surgery
Volume 199, Issue 2 , Pages 199-203, February 2010

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

Presented as a scientific exhibit at the 67th meeting of the American Association for the Surgery of Trauma, Maui, Hawaii, September 24–27, 2008.

Division of Trauma and Critical Care, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA

Received 20 February 2009; received in revised form 31 March 2009

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.

Keywords: Chest tube, Chest x-ray, Chest tube removal, Tube thoracostomy