Is routine chest X-ray following tracheostomy in children necessary?

Tracheostomy is a common surgical procedure. Despite the lack of strong supporting evidence, routine post-tracheostomy chest radiography is usually performed to evaluate for complications such as pneumothorax, pneumomediastinum, and tube malposition. Recent studies have questioned the necessity of this practice, particularly in adults. This study aimed to assess the role of routine post-tracheostomy chest X-rays in the pediatric population.

Retrospective cohort study.

Tertiary medical center.

Medical records of 189 pediatric patients who underwent tracheostomy between January 1, 2013, and September 7, 2023, were retrospectively reviewed. Demographic and clinical data were recorded, and imaging studies were analyzed.

During the study period, 189 pediatric tracheostomies were performed. Patients' ages ranged from 2 weeks to 17 years, with a median age of 18 months. Postoperative chest X-rays were performed on all patients and interpreted by radiologists. New findings were observed in 28 patients (14 %), with half showing worsening preexisting conditions. No cases of pneumothorax, pneumomediastinum, or tube malposition were detected, and no chest X-ray results led to changes in patient management.

Our results suggest that the practice of routine post-tracheostomy CXR in children is debatable owing to its low yield and minimal impact on clinical management.