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The value of routine posttracheostomy chest radiography
M Tarnoff1, M Moncure, F Jones
1Department of Surgery, UMDNJ-Robert Wood Johnson Medical School, Cooper Hospital/University Medical Center, Camden, NJ, USA.
Chest
|June 19, 1998
Summary
Routine posttracheostomy chest X-rays rarely change patient management, suggesting this practice may not be cost-effective. Further research is recommended to confirm the safety of discontinuing routine imaging after tracheostomy.
Area of Science:
- Medical Imaging
- Thoracic Surgery
- Critical Care Medicine
Background:
- Tracheostomy is a common procedure in critical care settings.
- Posttracheostomy chest radiography is often performed routinely.
Purpose of the Study:
- To evaluate the efficacy and cost-effectiveness of routine posttracheostomy chest radiography.
- To determine if routine imaging significantly impacts patient management or outcomes.
Main Methods:
- Retrospective chart review of 293 patients undergoing elective tracheostomy between 1989 and 1993 at a level-one trauma center.
- Analysis of preoperative and postoperative chest radiograph reports, and subsequent management changes.
- Exclusion of 25 patients with pre-existing chest tubes; 268 charts were analyzed.
Main Results:
- Only one patient (0.3%) had a pneumothorax, and eight (2.4%) had atelectasis; no significant management changes resulted from these findings.
- No new infiltrates, effusions, or malpositioned tubes were detected.
- Eliminating routine posttracheostomy radiographs could save an estimated $52.39 per patient.
Conclusions:
- Routine posttracheostomy chest radiography infrequently reveals abnormalities that alter patient management, questioning its routine use due to associated costs.
- A randomized, prospective study is recommended to assess the safety of discontinuing this practice.