title: Do X-rays after chest tube removal change patient management?
abstract: BACKGROUND
  A link between childhood radiation and future cancer risks exists, and reduction of unnecessary radiation in childhood has been recommended. Pneumothoraces, pleural effusions, and many surgical procedures require placement of a chest tube/pigtail catheter. Traditional management is daily x-rays, with an x-ray after tube removal. Our hypothesis is the "post pull" x-ray rarely results in changing clinical management of the patient.
  
  
  METHODS
  With IRB approval, a 5-year retrospective chart review was performed. Inclusion criteria were chest tube or pigtail placed for any reason with complete records. Data collected were demographics, reason for and duration of placement, number of x-rays done prior to and after removal. Primary outcome was whether the "post pull" x-ray changed clinical management.
  
  
  RESULTS
  A total of 179 episodes were evaluated. Seventeen were excluded for incomplete data, or death/transfer of the patient with the tube in situ. Forty-nine tubes/pigtails were placed for pneumothorax, 48 for pleural effusion/empyema, 9 for hemothorax, and 51 during operative procedure. A median of 5 x-rays was done post insertion. 99% of the patients (160/162) had a "post pull" x-ray performed after tube removal. In 9 cases the x-ray changed patient management.
  
  
  CONCLUSIONS
  X-ray after chest tube/pigtail removal rarely changes patient management. We recommend considering imaging if there are clinical symptoms.
  
  
  METHODS
  Prognosis study, level II (retrospective cohort).
authors.affiliation: University of Texas Southwestern, Department of Surgery, Division of Pediatric General and Thoracic Surgery, Dallas, TX.
authors.forename: Bret
authors.initials: B
authors.lastname: Johnson
authors.affiliation: Children's Health, Children's Medical Center Plano, Plano, TX.
authors.forename: Michele
authors.initials: M
authors.lastname: Rylander
authors.affiliation: University of Texas Southwestern, Department of Surgery, Division of Pediatric General and Thoracic Surgery, Dallas, TX. Electronic address: alana.beres@mail.mcgill.ca.
authors.forename: Alana L
authors.initials: AL
authors.lastname: Beres
mesh_terms: D000293:Adolescent; D015505:Chest Tubes; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making / Q000379:methods*; D020878:Device Removal; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000628:therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013907:Thoracostomy / Q000295:instrumentation
keywords: Chest tube; Pigtail; Pneumothorax; Tube thoracostomy; X-ray