Is a Chest Radiograph Required After Removal of Chest Tubes in Children?

McGrath, Ellen; Ranstrom, Lee; Lajoie, Debra; McGlynn, Lauren; Mooney, David P.

doi:10.1016/j.pedhc.2017.04.014

Cited by 21 publications

(25 citation statements)

References 11 publications

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“…12,13 Several studies in pediatric and cardiothoracic surgery suggest that the clinical value of the routine postremoval chest radiographs is low, as compared with selective use of chest radiographs only, and that it may be cost effective to only use selective chest radiographs in patients who demonstrate clinical symptoms. [14][15][16][17][18][19][20][21] Evidently, as global health care costs are rising, avoidable costs such as irrelevant diagnostics, which may lead to a prolonged hospital length of stay, should be prevented as well as unnecessary radiation exposure. 22 Even though there seems to be a trend toward omission of the postremoval chest radiograph in various disciplines, studies on this subject in trauma patients are scarce, and so consensus remains absent.…”

mentioning

confidence: 99%

Is a chest radiograph indicated after chest tube removal in trauma patients? A systematic review

Sweet¹,

Beks²,

Jong³

et al. 2021

J Trauma Acute Care Surg

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mentioning

confidence: 99%

Is a chest radiograph indicated after chest tube removal in trauma patients? A systematic review

Sweet¹,

Beks²,

Jong³

et al. 2021

J Trauma Acute Care Surg

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“…After the full-text screening, 18 studies were included in the systematic review. Eleven studies were conducted in the United States of America [1][2][3]7,[10][11][12][13][14][15][16] , four studies in the United Kingdom [17][18][19][20] , one in the Netherlands 5 , one in Germany 21 and one in Iran 6 (Table 1). No other studies were identified through manual screening of references of the included studies and relevant reviews.…”

Section: Resultsmentioning

confidence: 99%

“…In the post-drain removal chest X-rays, the incidence of pneumothorax is 3.1-3.9% 3,12 with a re-intervention rate is 0.7-1.7%. 12,13,16 Clinical symptoms were present in all patients who required re-intervention.…”

Section: Thoracic Surgery Paediatric Patientsmentioning

confidence: 99%

“…Four retrospective studies with a total of 708 paediatric patients investigated the necessity of performing routine chest X-rays after the removal of chest drains. 3,12,13,16 The mean age of patients in the studies ranges from 7.5 to 9.4 years. The patients underwent various thoracic surgical procedures including VATS and open surgeries.…”

Section: Thoracic Surgery Paediatric Patientsmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of Chest X-Rays after Drain Removal in Adult and Paediatric Patients Undergoing Cardiac and Thoracic Surgery: A Systematic Review

Thet

Han

Hlwar

et al. 2022

Preprint

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Background: Chest X-rays are routinely obtained after removal of chest drains in patients undergoing cardiac and thoracic surgical procedures. However, a lack of guidelines and evidence could question the practice. Routine chest X-rays increase exposure to ionising radiation, increase healthcare costs and lead to overutilisation of available resources. This review aims to explore the evidence in the literature regarding the routine use of chest X-rays following the removal of chest drains. Materials & Method: A systematic literature search was conducted in PubMed, Medline via Ovid, Cochrane central register of control trials (CENTRAL) and ClinicalTrials.gov without any limit on the publication year. The references of the included studies are manually screened to identify potentially eligible studies. Results: A total of 375 studies were retrieved through the search and 18 studies were included in the review. Incidence of pneumothorax remains less than 10% across adult cardiac, and paediatric cardiac and thoracic surgical populations. The incidence may be as high as 50% in adult thoracic surgical patients. However, the re-intervention rate remains less than 2% across the populations. Development of respiratory and cardiovascular symptoms can adequately guide for a chest X-ray following the drain removal. As an alternative, bedside ultrasound can be used to detect pneumothorax in the thorax after the removal of a chest drain without the need for ionising radiation. Conclusion: A routine chest X-ray following chest drain removal in adult and paediatric patients undergoing cardiac and thoracic surgery is not necessary. It can be omitted without compromising patient safety. Obtaining a chest X-ray should be clinically guided. Alternatively, bedside ultrasound can be used for the same purpose without the need for radiation exposure.

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“…During removal of large-bore chest tubes, it is possible for air to enter the thoracic cavity and cause a pneumothorax which may be evident on the post-pull CXR. However, multiple studies of large-bore chest tubes have examined the utility of post-pull CXRs in both pediatric [4,5,[15][16][17], and adult patients [3,[18][19][20] and found that postpull CXRs only rarely change patient management, and in most cases, additional interventions are predicted by clinical symptoms and signs. Post-pull CXRs in neonates, who are less able to express symptoms such as shortness of breath, have also been found to have low utility, and rarely predict the need for chest tube reinsertion [21].…”

Section: Discussionmentioning

confidence: 99%

Routine chest X-rays after pigtail chest tube removal rarely change management in children

et al. 2021

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Background The need for chest X-rays (CXR) following large-bore chest tube removal has been questioned; however, the utility of CXRs following removal of small-bore pigtail chest tubes is unknown. We hypothesized that CXRs obtained following removal of pigtail chest tubes would not change management. Methods Patients < 18 years old with pigtail chest tubes placed 2014–2019 at a tertiary children’s hospital were reviewed. Exclusion criteria were age < 1 month, death or transfer with a chest tube in place, or pigtail chest tube replacement by large-bore chest tube. The primary outcome was chest tube reinsertion. Results 111 patients underwent 123 pigtail chest tube insertions; 12 patients had bilateral chest tubes. The median age was 5.8 years old. Indications were pneumothorax (n = 53), pleural effusion (n = 54), chylothorax (n = 6), empyema (n = 5), and hemothorax (n = 3). Post-pull CXRs were obtained in 121/123 cases (98.4%). The two children without post-pull CXRs did not require chest tube reinsertion. Two patients required chest tube reinsertion (1.6%), both for re-accumulation of their chylothorax. Conclusions Post-pull chest X-rays are done nearly universally following pigtail chest tube removal but rarely change management. Providers should obtain post-pull imaging based on symptoms and underlying diagnosis, with higher suspicion for recurrence in children with chylothorax.

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Is a Chest Radiograph Required After Removal of Chest Tubes in Children?

Cited by 21 publications

References 11 publications

Is a chest radiograph indicated after chest tube removal in trauma patients? A systematic review

Is a chest radiograph indicated after chest tube removal in trauma patients? A systematic review

Efficacy of Chest X-Rays after Drain Removal in Adult and Paediatric Patients Undergoing Cardiac and Thoracic Surgery: A Systematic Review

Routine chest X-rays after pigtail chest tube removal rarely change management in children

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