Slak Peter, Winant Abbey J, Lee Edward Y, Plut Domen
Clinical Institute of Radiology, University Medical Centre Ljubljana.
University of Ljubljana Faculty of Medicine, Ljubljana, Slovenia.
J Thorac Imaging. 2023 Jan 1;38(1):10-17. doi: 10.1097/RTI.0000000000000660. Epub 2022 Jun 17.
Chest tube placement and subsequent removal is a routine step in patient management after cardiovascular surgery. The purpose of this retrospective study is to determine the necessity of routine chest radiography following chest tube removal in order to detect potential complications in pediatric patients after cardiovascular surgery.
We retrospectively reviewed the hospital records of all consecutive children up to 5 years of age who had cardiovascular surgery at our hospital between January 2015 and December 2020. Two radiologists independently evaluated routine chest radiographs performed 4 hours following chest tube removal for the presence of potential complications. In all post chest tube removal chest radiographs that demonstrated a complication, the patient's medical record was investigated in order to determine if there was an associated clinical or laboratory test abnormality, and if the radiographically detected complication led to a change in patient management. Inter-rater agreement between the 2 reviewers was evaluated with κ statistics.
We identified 147 children (73 [49.7%] male and 74 [50.3%] female; mean age=13.8 mo old; range 0 to 60 mo) who met the inclusion criteria. Complications were detected on routine chest radiograph after chest tube removal in 10 patients (6.8%) including pneumothorax (n=5, 3.4%), pleural effusion (n=3, 2%), pneumomediastinum (n=1, 0.7%), and pneumopericardium (n=1, 0.7%). No clinical or laboratory abnormalities were present in all children affected with radiographically detected complications on routine chest radiograph 4 hours after chest tube removal, and there was no need for intervention in any affected patients. There was high inter-rater κ agreement between the 2 independent reviewers for detecting complications on chest radiographs after chest tube removal (κ=0.94).
Our study shows that routine chest radiograph performed shortly after chest tube removal may not be necessary for the safe management of asymptomatic children after cardiovascular surgery because complications are rare and do not require intervention. In addition, obviating performance of this routine chest radiograph following chest tube removal will lead to a substantial decrease in exposure to unnecessary ionizing radiation in children who undergo frequent radiographs and lower medical costs.
放置并随后拔除胸管是心血管手术后患者管理中的常规步骤。本回顾性研究的目的是确定在小儿心血管手术后拔除胸管后进行常规胸部X线检查以检测潜在并发症的必要性。
我们回顾性分析了2015年1月至2020年12月期间在我院接受心血管手术的所有连续5岁及以下儿童的医院记录。两名放射科医生独立评估了在拔除胸管4小时后进行的常规胸部X线片，以确定是否存在潜在并发症。在所有显示有并发症的拔除胸管后的胸部X线片中，对患者病历进行调查，以确定是否存在相关的临床或实验室检查异常，以及影像学检测到的并发症是否导致患者管理的改变。使用κ统计量评估两位阅片者之间的一致性。
我们确定了147名符合纳入标准的儿童（73名[49.7%]男性和74名[50.3%]女性；平均年龄=13.8个月；范围0至60个月）。10名患者（6.8%）在拔除胸管后的常规胸部X线片上检测到并发症，包括气胸（n=5，3.4%）、胸腔积液（n=3，2%）、纵隔气肿（n=1，0.7%）和心包积气（n=1，0.7%）。在拔除胸管4小时后，所有在常规胸部X线片上影像学检测到并发症的儿童均无临床或实验室异常，且任何受影响患者均无需干预。两位独立阅片者在检测拔除胸管后的胸部X线片上的并发症方面具有较高的阅片者间κ一致性（κ=0.94）。
我们的研究表明，对于心血管手术后无症状的儿童，拔除胸管后不久进行常规胸部X线检查对于安全管理可能不必要，因为并发症罕见且无需干预。此外，在拔除胸管后省略此常规胸部X线检查将导致接受频繁X线检查的儿童不必要的电离辐射暴露大幅减少，并降低医疗成本。
