The Utility of Early versus Delayed CXR After Chest Tube Removal
Emily H Johnson1,2, Nathan H Schmoekel1, Janet S Lee1,2
1Department of Trauma and Acute Care Surgery, UCHealth Memorial Hospital, Colorado Springs, CO, USA.
The American Surgeon
|August 26, 2025
Summary
Post-pull chest X-rays (ppCXR) after chest tube removal in trauma patients do not impact reintervention rates, regardless of timing. Early or delayed ppCXR showed similar radiographic changes and outcomes, questioning routine use.
Area of Science:
- Trauma Surgery
- Diagnostic Imaging
- Thoracic Medicine
Background:
- Post-pull chest X-rays (ppCXR) are standard after chest tube (CT) removal but their clinical utility is debated.
- Previous research indicates ppCXR rarely alter management, yet the influence of timing on outcomes remains unexplored.
- This study addresses the impact of early versus delayed ppCXR on radiographic findings and clinical decisions in trauma patients.
Purpose of the Study:
- To compare the effects of early (≤4 hours) versus delayed (>4 hours) post-pull chest X-rays on radiographic changes.
- To evaluate the impact of ppCXR timing on reintervention rates and clinical management in asymptomatic trauma patients.
- To determine if ppCXR timing influences radiographic findings or the need for further interventions after chest tube removal.
Main Methods:
- Retrospective analysis of asymptomatic trauma patients who underwent chest tube placement and removal at a Level 1 trauma center (2019-2022).
- Patients were categorized into early (≤4 hours) and delayed (>4 hours) post-pull chest X-ray groups.
- Primary outcome was reintervention (CT replacement, VATS, thoracotomy); secondary outcomes included radiographic changes and length of stay.
Main Results:
- No significant differences in radiographic changes (26.1% vs 29.3%) or reintervention rates (4.3% vs 5.6%) were observed between early and delayed ppCXR groups.
- Radiographic changes detected by ppCXR had low sensitivity (65.0%) and specificity (73.4%) for predicting reintervention.
- Delayed ppCXR was associated with a higher rate of unplanned ICU transfers (5.6%) compared to early ppCXR (0%).
Conclusions:
- The timing of post-pull chest X-rays does not significantly affect the detection of radiographic changes or reintervention rates in asymptomatic trauma patients.
- Findings support the growing evidence questioning the routine use of post-pull chest X-rays in this patient population.
- Further multicenter studies are needed to establish standardized protocols for imaging after chest tube removal in trauma care.
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