title: What is the yield of routine chest radiography following tube thoracostomy for trauma?
abstract: BACKGROUND
  Routine chest radiography (CXR) following tube thoracostomy (TT) is a standard practice in most trauma centres worldwide. Evidence supporting this routine practice is lacking and the actual yield is unknown.
  
  
  METHODS
  We performed a retrospective review of 1042 patients over a 4-year period who had a routine post-insertion CXR performed in accordance with current ATLS® recommendations.
  
  
  RESULTS
  A total 1042 TTs were performed on 1004 patients. Ninety-one per cent of patients (913/1004) were males, and the median age for all patients was 24 years. Seventy-five per cent of all injuries (756/1004) were from penetrating trauma, and the remaining 25% (248/1004) were from blunt. The initial pathologies requiring TT were: haemopneumothorax: 34% (339/1042), haemothroax: 31% (314/1042), simple pneumothorax: 25% (256/1042), tension pneumothorax: 8% (77/1042) and open pneumothorax: 5% (54/1042). One hundred and three patients had TTs performed on clinical grounds alone without a pre-insertion CXR [Group A]. One hundred and ninety-one patients had a pre-insertion CXR but had persistent clinical concerns following insertion [Group B]. Seven hundred and ten patients had pre-insertion CXR but no clinical concerns following insertion [Group C]. Overall, 15% (152/1004) [9 from Group A, 111 from Group B and 32 from Group C] of all patients had their clinical management influenced as a direct result of the post-insertion CXR.
  
  
  CONCLUSIONS
  Despite the widely accepted practice of routine CXR following tube thoracostomy, the yield is relatively low. In many cases, good clinical examination post tube insertion will provide warnings as to whether problems are likely to result. However, in the more rural setting, and in resource challenged environments, there is a relatively high yield from the CXR, which alters management. Further prospective studies are needed to establish or refute the role of the existing ATLS® guidelines in these specific environments.
authors: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg 3216, South Africa. Electronic address: victorywkong@yahoo.com.
authors: Victor Y
authors: VY
authors: Kong
authors: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg 3216, South Africa. Electronic address: george.oost@gmail.com.
authors: George V
authors: GV
authors: Oosthuizen
authors: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg 3216, South Africa. Electronic address: damianclar@gmail.com.
authors: Damian L
authors: DL
authors: Clarke
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D015276:Health Care Rationing; D006468:Hemopneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology; D017410:Practice Guidelines as Topic; D013902:Radiography, Thoracic / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019035:Rural Health Services / Q000706:statistics & numerical data*; D013019:South Africa / Q000453:epidemiology; D013898:Thoracic Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D013907:Thoracostomy / Q000379:methods*
keywords: Chest radiograph; Tube thoracostomy; Yield