title: Thoracic ultrasound can predict safe removal of thoracostomy tubes.
abstract: BACKGROUND
  Chest x-rays (CXRs) have been the mainstay for the management of thoracostomy tubes (TTs), but reports that ultrasound (US) may be more sensitive for detection of pneumothorax (PTX) continue to increase. The objective of this study was to determine if US is safe and effective for the detection of PTX following TT removal.
  
  
  METHODS
  This was a retrospectively reviewed, prospective process improvement project involving patients who had a TT managed by the surgical team. Bedside US was performed by experienced surgeon sonographers before and after TT removal. Initially, a CXR was obtained before and after TT removal, with sonographers blinded to CXR findings. Subsequently, routine CXR was no longer obtained, and TT removal was determined by US.
  
  
  RESULTS
  One hundred twenty-nine TTs were placed during the study. Initially, water seal and postpull US were performed on 49 TTs, with 6 tubes having only postpull imaging. US was able to detect all significant PTXs seen on CXR but identified one false-positive. Subsequently, 74 TTs had US imaging on water seal and after pull. Water seal US allowed the safe removal of 70% of the TTs. Twenty patients had no slide on water seal US and required follow-up CXR. Most importantly, US had a 100% negative predictive value for PTX during TT removal.
  
  
  CONCLUSIONS
  US is safe and effective for the rapid diagnosis of PTX. This has allowed the discontinuation of routine CXR for the evaluation of PTX during TT removal for patients with adequate lung slide seen on thoracic US lung windows.
  
  
  METHODS
  Diagnostic test, level II. Therapeutic study, level IV.
authors: From the Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia.
authors: Michael C
authors: MC
authors: Soult
authors: Jay N
authors: JN
authors: Collins
authors: Timothy J
authors: TJ
authors: Novosel
authors: Leonard J
authors: LJ
authors: Weireter
authors: L D
authors: LD
authors: Britt
mesh_terms: D000328:Adult; D015505:Chest Tubes / Q000009:adverse effects; D020878:Device Removal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011859:Radiography; D012189:Retrospective Studies; D013907:Thoracostomy / Q000009:adverse effects / Q000379:methods*; D014463:Ultrasonography