Zhao Oliver S, Peterson April, Patel Kalpnaben, Wilcox Lyndy
Department of Otolaryngology: Head and Neck Surgery Vanderbilt University Medical Center Nashville Tennessee USA.
Laryngoscope Investig Otolaryngol. 2024 Jul 9;9(4):e1302. doi: 10.1002/lio2.1302. eCollection 2024 Aug.
To evaluate the utility of ordering chest x-rays after pediatric tracheostomy tube placement in identifying acute, post-operative complications and how it impacts clinical decision-making.
In this retrospective cohort study, we identified tracheostomies performed in 139 pediatric patients through CPT codes over a 5-year period from 2013 to 2018. Manual chart review was performed for demographic and clinical characteristics, pre-procedure and post-procedure chest x-ray interpretations, and the presence of complications. Each complication was reviewed to see if action was taken due to post-procedure chest x-ray findings. Multivariable logistic regression was performed to determine associations with changes in pre-procedure versus post-procedure chest x-rays.
In a cohort of 139 pediatric patients with pre-procedure and post-procedure chest x-rays, 40 (28.8%) of patients had new significant post-procedure chest x-ray findings compared to pre-procedure chest x-ray findings. Of these 40 instances of changes in pre-procedure versus post-procedure chest x-ray findings, only eight resulted in action being taken due to the observed findings. Among these eight instances of action being taken, only one instance involved in invasive action being taken with a bronchoscopy. With multivariable regression analysis, patient age, race, gender, and the presences of genetic syndromes, were not found to be significant risk factors in predicting changes in pre-procedure versus post-procedure chest x-ray.
In our study, post-procedure chest x-ray after tracheostomy tube placement did not significantly impact clinical decision making. It may be worth reconsidering the value in routine chest x-rays after tracheostomy tube placement in pediatric patients.
评估小儿气管切开术后进行胸部X光检查在识别急性术后并发症方面的效用，以及其如何影响临床决策。
在这项回顾性队列研究中，我们通过CPT编码确定了2013年至2018年5年间139例小儿患者所进行的气管切开术。对人口统计学和临床特征、术前和术后胸部X光检查结果以及并发症的存在情况进行了人工病历审查。对每种并发症进行审查，以查看是否因术后胸部X光检查结果而采取了行动。进行多变量逻辑回归以确定术前与术后胸部X光变化之间的关联。
在一组有术前和术后胸部X光检查的139例小儿患者中，与术前胸部X光检查结果相比，40例（28.8%）患者术后胸部X光检查有新的显著发现。在这40例术前与术后胸部X光检查结果变化的情况中，只有8例因观察到的结果而采取了行动。在这8例采取行动的情况中，只有1例涉及通过支气管镜进行的侵入性操作。通过多变量回归分析，未发现患者年龄、种族、性别和遗传综合征的存在是预测术前与术后胸部X光变化的显著风险因素。
在我们的研究中，气管切开术后的胸部X光检查对临床决策没有显著影响。可能值得重新考虑小儿患者气管切开术后常规胸部X光检查的价值。
