Division of Pediatric General, Thoracic and Trauma Surgery, CHOC Children's Hospital of Orange County, 505 South Main Street, Suite 225, Orange, CA, 92868, USA.
Division of Pediatric General, Thoracic and Trauma Surgery, CHOC Children's Hospital of Orange County, University of California, Irvine Medical Center, Department of Surgery, 505 South Main Street, Suite 225, Orange, CA, 92868, USA.
Pediatr Surg Int. 2021 May;37(5):631-637. doi: 10.1007/s00383-020-04809-7. Epub 2021 Jan 1.
The purpose of this study was to determine if routine chest X-rays (CXRs) performed after chest tube (CT) removal in pediatric patients provide additional benefit for clinical management compared to observation of symptoms alone.
A single-center retrospective study was conducted of inpatients, 18 years or younger, who had a CT managed by the pediatric surgery team between July 2017 and May 2019. The study compared two groups: (1) patients who received a post-pull CXR and (2) those who did not. The primary outcome of the study was the need for intervention after CT removal.
102 patients had 116 CTs and met inclusion criteria; 79 post-pull CXRs were performed; the remaining 37 CT pulls did not have a follow-up CXR. No patients required CT replacement or surgery in the absence of symptoms. Three patients exhibited clinical symptoms that would have prompted intervention regardless of post-pull CXR results. One patient had an intervention guided by post-pull CXR results alone. Meanwhile, another patient had delayed onset of symptoms and intervention. No patients required an intervention in the group that did not have a post-pull CXR.
Chest X-ray after CT removal had a very low yield for changing clinical management of asymptomatic patients. Clinical symptoms predict the need for an intervention.
本研究旨在确定与仅观察症状相比，在小儿患者拔除胸腔引流管（CT）后进行常规胸部 X 光（CXR）检查是否能为临床管理提供额外的益处。
对 2017 年 7 月至 2019 年 5 月期间由小儿外科团队管理的住院患者（年龄在 18 岁以下）进行了一项单中心回顾性研究。研究比较了两组患者：（1）接受拔管后 CXR 的患者；（2）未接受的患者。该研究的主要结局是在 CT 拔出后需要进行干预。
102 名患者共有 116 例 CT 符合纳入标准；其中 79 例进行了拔管后 CXR；其余 37 例 CT 拔出后未进行后续 CXR。在没有症状的情况下，没有患者需要进行 CT 更换或手术。有 3 名患者出现了临床症状，无论拔管后 CXR 的结果如何，这些症状都需要进行干预。1 名患者仅根据拔管后 CXR 的结果进行了干预。另一名患者则出现了症状延迟出现和干预延迟的情况。在未进行拔管后 CXR 的患者中，没有患者需要进行干预。
CT 拔出后进行 X 光检查对无症状患者的临床管理改变的效果非常低。临床症状可预测是否需要进行干预。
