Hafezi Niloufar, Cromeens Barrett P, Morocho Bryant S, Raymond Jodi L, Landman Matthew P
Department of Surgery, Division of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, IN.
Department of Surgery, Guthrie Robert Packer Hospital, Sayre, PA.
J Surg Res. 2022 Jan;269:51-58. doi: 10.1016/j.jss.2021.06.072. Epub 2021 Sep 11.
Use of routine chest x-rays (CXR) following thoracostomy tube (TT) removal is highly variable and its utility is debated. We hypothesize that routine post-pull chest x-ray (PP-CXR) findings following TT removal in pediatric trauma would not guide the decision for TT reinsertion.
Patients ≤ 18 y who were not mechanically ventilated and undergoing final TT removal for a traumatic hemothorax (HTX) and/or pneumothorax (PTX) at a level I pediatric trauma center from 2010 to 2020 were retrospectively reviewed. The outcomes of interest were rate of PP-CXR and TT reinsertion rate following PP-CXR. Clinical predictors for worsened findings on PP-CXR were also assessed.
Fifty-nine patients were included. A CXR after TT removal was performed in 57 patients (97%), with 28% demonstrating worsened CXR findings compared to the prior film. Except for higher ISS (p = 0.033), there were no demographic or clinical predictors for worsened CXR findings. However, they were more likely to have additional films following the TT removal (p = 0.008) than those with stable or improved PP-CXR findings. One (1.8%) asymptomatic child with worsened PP-CXR findings had TT reinsertion based purely on their worsened PP-CXR findings.
The vast majority of PP-CXR did not guide TT reinsertion after pediatric thoracic trauma. Treatment algorithms may aid to reduce variability and potentially unnecessary routine films.
胸腔闭式引流管（TT）拔除后常规胸部X线检查（CXR）的使用差异很大，其效用也存在争议。我们假设小儿创伤患者TT拔除后的常规拔管后胸部X线检查（PP-CXR）结果不会指导TT重新插入的决策。
回顾性分析2010年至2020年在一级小儿创伤中心接受创伤性血胸（HTX）和/或气胸（PTX）治疗且未进行机械通气并正在接受TT最终拔除的18岁及以下患者。感兴趣的结果是PP-CXR的发生率和PP-CXR后的TT重新插入率。还评估了PP-CXR结果恶化的临床预测因素。
纳入59例患者。57例患者（97%）在TT拔除后进行了CXR检查，其中28%的患者CXR结果与之前的片子相比有所恶化。除了较高的损伤严重度评分（ISS）（p = 0.033）外，没有人口统计学或临床预测因素可预测CXR结果恶化。然而，与PP-CXR结果稳定或改善的患者相比，他们在TT拔除后更有可能进行额外的检查（p = 0.008）。一名（1.8%）无症状儿童的PP-CXR结果恶化，仅基于其恶化的PP-CXR结果进行了TT重新插入。
小儿胸部创伤后，绝大多数PP-CXR并未指导TT重新插入。治疗算法可能有助于减少变异性并潜在地减少不必要的常规检查。
