Futility of Radiographs After Chest Tube Removal (FRACTR) Trial.

Area of Science:

• Trauma Surgery
• Thoracic Medicine
• Diagnostic Imaging

Background:

• Routine post-procedural chest X-rays (CXR) after chest tube removal in trauma patients are common practice.
• The necessity of routine CXR in asymptomatic patients remains a subject of debate.
• This study investigates predictors of chest tube reinsertion and evaluates a selective imaging strategy.

Purpose of the Study:

• To identify clinical predictors of chest tube reinsertion in trauma patients.
• To assess the efficacy of a symptom-based, selective imaging approach versus routine post-removal CXR.
• To determine if clinical symptoms or CXR findings are more reliable indicators for reinsertion.

Main Methods:

• Retrospective cohort study of 650 trauma patients undergoing chest tube placement (2021-2024).
• Data collected included demographics, Injury Severity Score (ISS), ICU/ventilator days, waterseal use, and post-pull symptoms/CXR.
• Bivariate and multivariable logistic regression analyses were used to identify reinsertion predictors.

Main Results:

• The chest tube reinsertion rate was 10% among 539 eligible patients.
• Post-pull clinical symptoms were the strongest predictor of reinsertion (OR 28.38, P < 0.001).
• Shorter tube duration and waterseal use decreased reinsertion odds (OR 0.101, P = 0.008). CXR's positive predictive value (16.9%) was lower than symptoms (56.9%).

Conclusions:

• Clinical symptoms are the most reliable predictor for chest tube reinsertion after removal in trauma patients.
• A selective, symptom-guided imaging strategy, considering waterseal use and drainage duration, may reduce unnecessary CXRs.
• Prospective studies are needed to validate this selective imaging approach.