Cunningham Janine P, Knott E Marty, Gasior Alessandra C, Juang David, Snyder Charles L, St Peter Shawn D, Ostlie Daniel J
The Children's Mercy Hospital, Kansas City, MO.
The Children's Mercy Hospital, Kansas City, MO.
J Pediatr Surg. 2014 Oct;49(10):1493-5. doi: 10.1016/j.jpedsurg.2014.01.004. Epub 2014 Jan 28.
Obtaining a chest radiograph (CXR) after chest tube (CT) removal to rule out a pneumothorax is a universal practice. However, the yield of this CXR has not been well documented. Additionally, most iatrogenic pneumothoraces resulting from CT removal are atmospheric in origin, asymptomatic, and can be observed. Recently, we have begun to discontinue routine CXR for CT removal. We evaluated our experience with CT removal to clarify the usefulness of routine post CT removal CXR.
After IRB approval, a retrospective study was conducted on patients who had a CT placed in the past decade. Cardiac patients requiring a CT were excluded. Patient demographics, diagnosis, treatments, and outcomes were collected. Patients were divided into two groups, those with a CXR after CT removal (Group 1) and those without (Group 2). Percentages were compared with Chi square with Yates correction.
462 patients were identified (group 1=327, group 2=135). Indications for CT included; empyema (n=176), lung resection (n=146), pneumothorax (n=71), pleural effusion (n=26), spinal fusion (n=20), trauma (n=16), and miscellaneous (n=7). Seven patients (2.1%) in group 1 required reinsertion for pneumothorax (n=4), empyema (n=2), and pleural effusion (n=1) compared to 1 patient (0.7%) in group 2 who required reinsertion for pleural effusion. This difference was not significant (P=0.2).
In non-cardiac patients with a CT, tube reinsertion is uncommon and tube replacement is secondary to symptoms. Therefore, routine post CT removal CXR is not necessary. CXR in these patients should be obtained based upon clinical indications after CT removal.
在拔除胸管（CT）后进行胸部X光检查（CXR）以排除气胸是一种普遍的做法。然而，这种CXR的检出率尚未得到充分记录。此外，大多数因拔除CT导致的医源性气胸起源于大气，无症状且可观察到。最近，我们开始停止对拔除CT进行常规CXR检查。我们评估了我们拔除CT的经验，以阐明拔除CT后常规CXR的有用性。
经机构审查委员会（IRB）批准，对过去十年中放置过CT的患者进行了一项回顾性研究。排除需要CT的心脏病患者。收集患者的人口统计学、诊断、治疗和结果。患者分为两组，拔除CT后进行CXR的患者（第1组）和未进行CXR的患者（第2组）。百分比采用Yates校正的卡方检验进行比较。
共确定462例患者（第1组=327例，第2组=135例）。放置CT的指征包括：脓胸（n=176）、肺切除（n=146）、气胸（n=71）、胸腔积液（n=26）、脊柱融合（n=20）、创伤（n=16）和其他（n=7）。第1组中有7例患者（2.1%）因气胸（n=4）、脓胸（n=2）和胸腔积液（n=1）需要重新插入胸管，而第2组中有1例患者（0.7%）因胸腔积液需要重新插入胸管。这种差异不显著（P=0.2）。
在非心脏疾病且放置了CT的患者中，胸管重新插入并不常见，且胸管更换以症状为次要依据。因此，拔除CT后常规的CXR检查没有必要。这些患者应在拔除CT后根据临床指征进行CXR检查。
