title: Chest X-ray after tracheostomy is not necessary unless clinically indicated.
abstract: BACKGROUND
  Chest radiography is routinely used post-tracheostomy to evaluate for complications. Often, the chest X-ray findings do not change clinical management. The present study was conducted to evaluate the utility of post-tracheostomy X-rays.
  
  
  METHODS
  This retrospective review of 255 patients was performed at a single-center, university, level I trauma center. All patients underwent tracheostomy and were evaluated for postprocedure complications.
  
  
  RESULTS
  Of the 255 patients, 95.7% had no change in postprocedure chest X-ray findings. New significant chest X-ray findings were found in 4.3% of patients, including subcutaneous emphysema, pneumothorax, and new significant consolidation. Only three of these patients required change in clinical management, and all changes were based on clinical presentation alone.
  
  
  CONCLUSIONS
  Routine chest X-ray following tracheostomy fails to provide additional information beyond clinical examination. Therefore radiographic examination should be performed only after technically difficult procedures or if the patient experiences clinical deterioration. Significant cost savings and minimization of radiation exposure can be achieved when chest radiography after tracheostomy is performed exclusively for clinical indications.
authors.affiliation: Department of Surgery, Boston University School of Medicine, c/o Lana Ketlere, 88 East Newton Street, C515, Boston, MA 02118, USA. William.Tobler@bmc.org
authors.forename: William D
authors.initials: WD
authors.lastname: Tobler
authors.forename: Juan R
authors.initials: JR
authors.lastname: Mella
authors.forename: Joanna
authors.initials: J
authors.lastname: Ng
authors.forename: Anand
authors.initials: A
authors.lastname: Selvam
authors.forename: Peter A
authors.initials: PA
authors.lastname: Burke
authors.forename: Suresh
authors.initials: S
authors.lastname: Agarwal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D017721:Hospital Costs; D006801:Humans; D008404:Massachusetts; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000191:economics / Q000209:etiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000191:economics; D013902:Radiography, Thoracic / Q000191:economics; D012189:Retrospective Studies; D013352:Subcutaneous Emphysema / Q000000981:diagnostic imaging* / Q000191:economics / Q000209:etiology; D014139:Tracheostomy; D055815:Young Adult