Are routine chest X-rays following chest tube removal necessary in asymptomatic pediatric patients?
Lauren M Kanamori1, Yigit Guner2, David Gibbs2
1Division of Pediatric General, Thoracic and Trauma Surgery, CHOC Children's Hospital of Orange County, 505 South Main Street, Suite 225, Orange, CA, 92868, USA. lkanamori@choc.org.
Insights
Routine chest X-rays (CXRs) after chest tube (CT) removal in children offer minimal clinical benefit. Observation of symptoms alone is sufficient for guiding interventions, as CXRs rarely alter management in asymptomatic patients.
Area of Science:
- Pediatric Surgery
- Thoracic Medicine
- Diagnostic Imaging
Background:
- Chest tubes (CTs) are commonly used in pediatric patients.
- Post-procedural imaging is often standard practice.
- Evaluating the necessity of routine imaging after CT removal is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To assess the clinical utility of routine chest X-rays (CXRs) following chest tube (CT) removal in pediatric inpatients.
- To compare the impact of post-CT removal CXRs versus symptom observation on clinical management decisions.
Main Methods:
- A retrospective study analyzed pediatric patients (≤18 years) who underwent CT management.
- Patients were divided into two groups: those who received a post-pull CXR and those who did not.
- The primary endpoint was the need for intervention after CT removal.
Main Results:
- Of 102 patients (116 CTs), 79 had post-pull CXRs; 37 did not.
- No patients without symptoms required intervention, regardless of CXR results.
- One patient's intervention was guided by CXR, while another had delayed symptoms and intervention. Three symptomatic patients would have received intervention irrespective of CXR findings.
Conclusions:
- Routine chest X-rays after CT removal have a low yield in changing clinical management for asymptomatic pediatric patients.
- Clinical symptoms are reliable predictors for the need for intervention following CT removal.
Purpose:
The purpose of this study was to determine if routine chest X-rays (CXRs) performed after chest tube (CT) removal in pediatric patients provide additional benefit for clinical management compared to observation of symptoms alone.
Methods:
A single-center retrospective study was conducted of inpatients, 18 years or younger, who had a CT managed by the pediatric surgery team between July 2017 and May 2019. The study compared two groups: (1) patients who received a post-pull CXR and (2) those who did not. The primary outcome of the study was the need for intervention after CT removal.
Results:
102 patients had 116 CTs and met inclusion criteria; 79 post-pull CXRs were performed; the remaining 37 CT pulls did not have a follow-up CXR. No patients required CT replacement or surgery in the absence of symptoms. Three patients exhibited clinical symptoms that would have prompted intervention regardless of post-pull CXR results. One patient had an intervention guided by post-pull CXR results alone. Meanwhile, another patient had delayed onset of symptoms and intervention. No patients required an intervention in the group that did not have a post-pull CXR.
Conclusion:
Chest X-ray after CT removal had a very low yield for changing clinical management of asymptomatic patients. Clinical symptoms predict the need for an intervention.
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