The value of chest radiography after chest tube removal in nonventilated trauma patients: a post-hoc analysis of a multicenter prospective cohort study.
Journal
The journal of trauma and acute care surgery
ISSN: 2163-0763
Titre abrégé: J Trauma Acute Care Surg
Pays: United States
ID NLM: 101570622
Informations de publication
Date de publication:
20 Sep 2023
20 Sep 2023
Historique:
pubmed:
22
7
2023
medline:
22
7
2023
entrez:
22
7
2023
Statut:
aheadofprint
Résumé
Chest tubes are commonly placed in trauma care to treat life-threatening intrathoracic injuries by evacuating blood or air from the pleural cavity. Currently, it is common practice to routinely obtain chest radiographs between one to eight hours after chest tube removal, while the necessity of it has been questioned. This study describes the 'ins-and-outs' of chest tubes and evaluates the value of routine post-removal chest radiography in nonventilated trauma patients. A post-hoc analysis of a multicenter observational prospective cohort study was performed in blunt chest trauma patients admitted with multiple rib fractures to two level-1 trauma centers between January 2018 and March 2021, and treated with one or more chest tubes. Exclusion criteria were mechanical ventilation during chest tube removal, missing reports of post-removal chest radiography, transfer to another hospital, or mortality before chest tube removal. Descriptive analyses were performed to calculate the number of findings on post-removal chest radiographs and reinterventions. A total of 207 patients were included for analysis of whom 14 underwent bilateral chest tube placement, resulting in 221 chest tube removals investigated in this study. The mean age was 58 ± 17 years, 71% were male, 73% were ASA 1 - 2, and the median ISS was 19 (IQR 14 - 29). In 68 out of 221 (31%) chest tube removals, post-removal chest radiography showed increased or recurrent intrathoracic pathology (i.e., 13% pneumothorax, 18% pleural fluid, and 8% atelectasis). Only two (3%) of these patients underwent a same-day reintervention based on these findings, of whom one had signs or symptoms of recurrent pathology, and one was asymptomatic. It seems safe to omit routine use of post-removal chest radiography in nonventilated blunt chest trauma patients and to selectively use imaging in those patients presenting with clinical signs or symptoms after chest tube removal. Level II, Diagnostic Tests/Criteria.
Sections du résumé
BACKGROUND
BACKGROUND
Chest tubes are commonly placed in trauma care to treat life-threatening intrathoracic injuries by evacuating blood or air from the pleural cavity. Currently, it is common practice to routinely obtain chest radiographs between one to eight hours after chest tube removal, while the necessity of it has been questioned. This study describes the 'ins-and-outs' of chest tubes and evaluates the value of routine post-removal chest radiography in nonventilated trauma patients.
METHODS
METHODS
A post-hoc analysis of a multicenter observational prospective cohort study was performed in blunt chest trauma patients admitted with multiple rib fractures to two level-1 trauma centers between January 2018 and March 2021, and treated with one or more chest tubes. Exclusion criteria were mechanical ventilation during chest tube removal, missing reports of post-removal chest radiography, transfer to another hospital, or mortality before chest tube removal. Descriptive analyses were performed to calculate the number of findings on post-removal chest radiographs and reinterventions.
RESULTS
RESULTS
A total of 207 patients were included for analysis of whom 14 underwent bilateral chest tube placement, resulting in 221 chest tube removals investigated in this study. The mean age was 58 ± 17 years, 71% were male, 73% were ASA 1 - 2, and the median ISS was 19 (IQR 14 - 29). In 68 out of 221 (31%) chest tube removals, post-removal chest radiography showed increased or recurrent intrathoracic pathology (i.e., 13% pneumothorax, 18% pleural fluid, and 8% atelectasis). Only two (3%) of these patients underwent a same-day reintervention based on these findings, of whom one had signs or symptoms of recurrent pathology, and one was asymptomatic.
CONCLUSIONS
CONCLUSIONS
It seems safe to omit routine use of post-removal chest radiography in nonventilated blunt chest trauma patients and to selectively use imaging in those patients presenting with clinical signs or symptoms after chest tube removal.
LEVEL OF EVIDENCE
METHODS
Level II, Diagnostic Tests/Criteria.
Identifiants
pubmed: 37480167
doi: 10.1097/TA.0000000000004105
pii: 01586154-990000000-00456
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.
Déclaration de conflit d'intérêts
Conflict of interest statement: The authors have nothing to disclose.