Division of Trauma and Critical Care, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA.
Am J Surg. 2010 Feb;199(2):199-203. doi: 10.1016/j.amjsurg.2009.03.011.
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.
A retrospective review of chest tube insertions performed at a level I trauma center was conducted.
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.
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.
尚未制定关于创伤患者在胸腔引流管移除后进行胸部 X 光（CXR）检查的明确实用指南。作者假设选择性地在胸腔引流管移除后进行 CXR 检查是安全且具有成本效益的。
对一级创伤中心进行的胸腔引流管插入的回顾性研究。
在没有进行后续 CXR 的情况下接受胸腔引流管移除的患者的平均损伤严重程度评分较低，且更不可能发生穿透性胸部损伤。这些患者接受的总 CXR 数量较少，胸腔引流管治疗的持续时间和管移除后的住院时间更短。在 CXR 组中，后续的再介入治疗更为频繁。通过放弃 CXR 检查，每年可减少医院费用 16,280 美元。
在受伤程度较轻、未接受通气的患者中选择性地省略胸腔引流管移除后的 CXR 检查不会对结果产生不利影响或增加再介入率。避免在胸腔引流管移除后进行不必要的常规 CXR 检查可以显著降低总住院费用。
