Abstract
Introduction
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.
Materials and 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.
Keywords
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Article info
Publication history
Published online: June 23, 2014
Accepted:
June 14,
2014
Identification
Copyright
© 2014 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
