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Is Routine Roentgenography Needed after Closed Tube Thoracostomy Removal?

Pacanowski, John P. MD; Waack, Matthew L. MD; Daley, Brian J. MD; Hunter, Karen S. MD; Clinton, Richard BS; Diamond, Daniel L. MD; Enderson, Blaine L. MD

Journal of Trauma and Acute Care Surgery: April 2000 - Volume 48 - Issue 4 - p 684-688
Article Titles

Background: Efficacy of chest radiograph protocol after tube thoracostomy tube (CT) removal.

Methods: Retrospective review (July of 1995 to July of 1996) of 141 patients with CT followed throughout their hospitalization. Excluded patients died (23 patients) or had thoracotomy (13 patients) before CT removal.

Results: A total of 105 patients had 113 CT removed (mean age, 36.9 years; Injury Severity Score = 23.4; CT duration, 5.0 days). Protocol chest radiographs were performed on average at 7.9 and 22.1 hours. Recurrent pneumothorax (RHPTX = new interpleural air) occurring in 12 patients (11%) and persistent pneumothorax (PHPTX = same volume of interpleural air) occurring in 13 patients (12%) caused no clinical problems and were treated without tube replacement. Three patients had symptoms after removal; none had RHPTX. Two patients had clinical signs; one reaccumulated a hemothorax requiring CT replacement, the other improved without replacement.

Conclusions: Clinically significant RHPTX/PHPTX after CT removal is infrequent. Signs not symptoms detect CT removal complications. At our institution, chest radiographs are obtained in a delayed manner from protocol and offer no benefit over clinical assessment.

From the Division of Trauma and Critical Care, Department of Surgery (J.P.P., B.J.D., K.S.H., R.C., D.L.D., B.L.E.) and Department of Radiology (M.L.W.), The University of Tennessee Medical Center at Knoxville, Knoxville, Tennessee.

Address for reprints: Brian J. Daley, MD, Division of Trauma and Critical Care, Department of Surgery, The University of Tennessee Medical Center at Knoxville, Box U-11, 1924 Alcoa Highway, Knoxville, TN 37920; email:

Submitted for publication May 12, 1998.

Accepted for publication December 23, 1999.

Poster presentation at the 57th Annual Meeting of the American Association for the Surgery of Trauma, September 24–27, 1997, Waikoloa, Hawaii.

© 2000 Lippincott Williams & Wilkins, Inc.