title: Is routine chest radiograph necessary after chest tube removal?
abstract: BACKGROUND
  Obtaining a chest radiograph (CXR) after chest tube (CT) removal to rule out a pneumothorax is a universal practice. However, the yield of this CXR has not been well documented. Additionally, most iatrogenic pneumothoraces resulting from CT removal are atmospheric in origin, asymptomatic, and can be observed. Recently, we have begun to discontinue routine CXR for CT removal. We evaluated our experience with CT removal to clarify the usefulness of routine post CT removal CXR.
  
  
  METHODS
  After IRB approval, a retrospective study was conducted on patients who had a CT placed in the past decade. Cardiac patients requiring a CT were excluded. Patient demographics, diagnosis, treatments, and outcomes were collected. Patients were divided into two groups, those with a CXR after CT removal (Group 1) and those without (Group 2). Percentages were compared with Chi square with Yates correction.
  
  
  RESULTS
  462 patients were identified (group 1=327, group 2=135). Indications for CT included; empyema (n=176), lung resection (n=146), pneumothorax (n=71), pleural effusion (n=26), spinal fusion (n=20), trauma (n=16), and miscellaneous (n=7). Seven patients (2.1%) in group 1 required reinsertion for pneumothorax (n=4), empyema (n=2), and pleural effusion (n=1) compared to 1 patient (0.7%) in group 2 who required reinsertion for pleural effusion. This difference was not significant (P=0.2).
  
  
  CONCLUSIONS
  In non-cardiac patients with a CT, tube reinsertion is uncommon and tube replacement is secondary to symptoms. Therefore, routine post CT removal CXR is not necessary. CXR in these patients should be obtained based upon clinical indications after CT removal.
authors.affiliation: The Children's Mercy Hospital, Kansas City, MO.
authors.forename: Janine P
authors.initials: JP
authors.lastname: Cunningham
authors.affiliation: The Children's Mercy Hospital, Kansas City, MO.
authors.forename: E Marty
authors.initials: EM
authors.lastname: Knott
authors.affiliation: The Children's Mercy Hospital, Kansas City, MO.
authors.forename: Alessandra C
authors.initials: AC
authors.lastname: Gasior
authors.affiliation: The Children's Mercy Hospital, Kansas City, MO.
authors.forename: David
authors.initials: D
authors.lastname: Juang
authors.affiliation: The Children's Mercy Hospital, Kansas City, MO.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Snyder
authors.affiliation: The Children's Mercy Hospital, Kansas City, MO.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.affiliation: The Children's Mercy Hospital, Kansas City, MO. Electronic address: ostlie@surgery.wisc.edu.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ostlie
mesh_terms: D000293:Adolescent; D015505:Chest Tubes; D002648:Child; D020878:Device Removal / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology; D013902:Radiography, Thoracic; D012140:Respiratory Tract Diseases / Q000601:surgery; D012189:Retrospective Studies; D013907:Thoracostomy / Q000295:instrumentation
keywords: Chest radiographs; Chest tube; Pediatrics