title: Are chest radiographs routinely necessary following thoracostomy tube removal?
abstract: OBJECTIVE
  Chest radiographs (CXRs) are routinely obtained at many institutions in all pediatric patients following thoracostomy tube removal to search for pneumothorax (PTX). To aid in evaluating the necessity of this practice, this study investigates whether clinical signs and symptoms may be a sensitive predictor of PTX in such patients.
  
  
  METHODS
  Reports from CXRs obtained following chest tube removal in all pediatric patients (374 patients) who underwent cardiac surgery with chest tube placement over 1 year were reviewed. For cases with reported PTX, the PTX was quantified and chart review was performed to assess whether signs and symptoms of PTX preceded the CXR result.
  
  
  RESULTS
  Fifty-one of 374 children (13.6%) had a radiographically defined PTX within 6 h after thoracostomy tube removal. The PTX was large (>40%) in 2 children, moderate (20-40%) in 5 children, and small (<20%) in 44 children. Symptoms (dyspnea, tachypnea, respiratory distress) or signs (increased oxygen requirement, worsening arterial blood gas and/or hypotension) of respiratory distress were present at the time of the initial CXR in six of seven patients, who later underwent a major clinical intervention, and in one patient who did not. Major clinical interventions were performed in all patients with a large PTX, four of five patients with a moderate PTX, and one patient with a small PTX that later enlarged.
  
  
  CONCLUSIONS
  Clinical signs and symptoms identified nearly all patients with significant pneumothoraces. Future prospective investigations may examine reserving chest radiography following chest tube removal for select groups, such as symptomatic patients or those with tenuous cardiovascular status.
authors.affiliation: Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628, USA.
authors.forename: Preeyacha
authors.initials: P
authors.lastname: Pacharn
authors.forename: Daniel N D
authors.initials: DN
authors.lastname: Heller
authors.forename: Bamidele F
authors.initials: BF
authors.lastname: Kammen
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Bryce
authors.forename: Mohan V
authors.initials: MV
authors.lastname: Reddy
authors.forename: Richard A
authors.initials: RA
authors.lastname: Bailey
authors.forename: Robert C
authors.initials: RC
authors.lastname: Brasch
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures; D015505:Chest Tubes; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic / Q000592:standards; D012008:Recurrence; D012189:Retrospective Studies; D013907:Thoracostomy / Q000009:adverse effects*