Sweet Arthur A R, Kobes Tim, Houwert Roderick M, Leenen Luke P H, de Jong Pim A, Veldhuis Wouter B, IJpma Frank F A, van Baal Mark C P M
From the Department of Surgery (A.A.R.S., T.K., R.M.H., L.P.H.L., M.C.P.M.v.B.) and Department of Radiology (A.A.R.S., T.K., P.A.d.J., W.B.V.), University Medical Center Utrecht, Utrecht; Department of Surgery (F.F.A.I.), University Medical Center Groningen, Groningen, the Netherlands.
J Trauma Acute Care Surg. 2024 Apr 1;96(4):623-627. doi: 10.1097/TA.0000000000004105. Epub 2023 Sep 20.
Chest tubes are commonly placed in trauma care to treat life-threatening intrathoracic injuries by evacuating blood or air from the pleural cavity. Currently, it is common practice to routinely obtain chest radiographs between 1 to 8 hours after chest tube removal, while the necessity of it has been questioned. This study describes the "ins-and-outs" of chest tubes and evaluates the value of routine postremoval chest radiography in nonventilated trauma patients.
A post hoc analysis of a multicenter observational prospective cohort study was performed in blunt chest trauma patients admitted with multiple rib fractures to two level 1 trauma centers between January 2018 and March 2021 and treated with one or more chest tubes. Exclusion criteria were mechanical ventilation during chest tube removal, missing reports of postremoval chest radiography, transfer to another hospital, or mortality before chest tube removal. Descriptive analyses were performed to calculate the number of findings on postremoval chest radiographs and reinterventions.
A total of 207 patients were included for analysis of whom 14 underwent bilateral chest tube placement, resulting in 221 chest tube removals investigated in this study. The mean ± SD age was 58 ± 17 years, 71% were male, 73% had American Society of Anesthesiologists scores of 1 or 2, and the median Injury Severity Score was 19 (interquartile range, 14-29). In 68 of 221 chest tube removals (31%), postremoval chest radiography showed increased or recurrent intrathoracic pathology (i.e., 13% pneumothorax, 18% pleural fluid, and 8% atelectasis). Only two (3%) of these patients underwent a same-day reintervention based on these findings, of whom one had signs or symptoms of recurrent pathology and one was asymptomatic.
It seems safe to omit routine use of postremoval chest radiography in nonventilated blunt chest trauma patients and to selectively use imaging in those patients presenting with clinical signs or symptoms after chest tube removal.
Diagnostic Tests/Criteria; Level IV.
胸腔引流管常用于创伤治疗，通过排出胸腔内的血液或气体来治疗危及生命的胸内损伤。目前，在胸腔引流管拔除后1至8小时内常规进行胸部X线检查是常见做法，但其必要性受到质疑。本研究描述了胸腔引流管的“来龙去脉”，并评估了非通气创伤患者拔除胸腔引流管后常规胸部X线检查的价值。
对一项多中心观察性前瞻性队列研究进行事后分析，研究对象为2018年1月至2021年3月期间因多根肋骨骨折入住两个一级创伤中心并接受一根或多根胸腔引流管治疗的钝性胸部创伤患者。排除标准为胸腔引流管拔除期间机械通气、拔除胸腔引流管后胸部X线检查报告缺失、转至其他医院或在胸腔引流管拔除前死亡。进行描述性分析以计算拔除胸腔引流管后胸部X线检查的发现数量和再次干预情况。
共纳入207例患者进行分析，其中14例接受双侧胸腔引流管置入，本研究共调查了221次胸腔引流管拔除情况。平均年龄±标准差为58±17岁，71%为男性，73%的美国麻醉医师协会评分为1或2，损伤严重程度评分中位数为19（四分位间距，14 - 29）。在221次胸腔引流管拔除中的68次（31%），拔除胸腔引流管后胸部X线检查显示胸内病变增加或复发（即13%气胸、18%胸腔积液和8%肺不张）。这些患者中只有两名（3%）基于这些发现于当日接受了再次干预，其中一名有复发病变的体征或症状，另一名无症状。
对于非通气钝性胸部创伤患者，省略拔除胸腔引流管后常规胸部X线检查似乎是安全的，对于拔除胸腔引流管后出现临床体征或症状的患者可选择性使用影像学检查。
诊断试验/标准；四级。
