Omission of routine chest x-ray after chest tube removal is safe in selected trauma patients.
BACKGROUND
Definitive practice guidelines regarding the utility of chest x-ray (CXR) following chest tube removal in trauma patients have not been established. The authors hypothesized that the selective use of CXR following chest tube removal is safe and cost effective.


METHODS
A retrospective review of chest tube insertions performed at a level I trauma center was conducted.


RESULTS
Patients who underwent chest tube removal without subsequent CXR had a lower mean Injury Severity Score and were less likely to have suffered penetrating thoracic injuries. These patients received fewer total CXRs and had shorter durations of chest tube therapy and shorter lengths of stay following tube removal. Subsequent reinterventions were performed more frequently in the CXR group. The annual decrease in hospital charges by foregoing a CXR was $16,280.


CONCLUSIONS
The selective omission of CXR following chest tube removal in less severely injured, nonventilated patients does not adversely affect outcomes or increase reintervention rates. Avoiding unnecessary routine CXR after chest tube removal could provide a significant reduction in total hospital charges.
Goodman
Michael D
MD
Division of Trauma and Critical Care, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. goodmamd@uc.edu
Huber
Nathan L
NL
Johannigman
Jay A
JA
Pritts
Timothy A
TA
D000328:Adult; D015505:Chest Tubes / Q000191:economics; D003362:Cost-Benefit Analysis; D020878:Device Removal / Q000191:economics; D005260:Female; D006491:Hemothorax / Q000000981:diagnostic imaging* / Q000191:economics / Q000209:etiology / Q000628:therapy; D017722:Hospital Charges; D006801:Humans; D008297:Male; D009820:Ohio; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000191:economics / Q000209:etiology / Q000628:therapy; D011859:Radiography; D012189:Retrospective Studies; D012449:Safety; D055502:Secondary Prevention; D013898:Thoracic Injuries / Q000150:complications* / Q000191:economics / Q000628:therapy; D013907:Thoracostomy / Q000191:economics