Highlights
- •Bedside ultrasound may safely replace chest radiograph after trauma tube thoracostomy removal.
- •Chest ultrasound was safely and accurately performed by surgical interns with minimal training.
- •Using chest ultrasound, rather than x-ray, after thoracostomy removal may save healthcare dollars.
Abstract
Introduction
A chest radiograph (CXR) is routinely obtained in trauma patients following tube thoracostomy
(TT) removal to assess for residual pneumothorax (PTX). New literature supports the
deference of a radiograph after routine removal procedure. However, many surgeons
have hesitated to adopt this practice due to concern for patient welfare and medicolegal
implications. Ultrasound (US) is a portable imaging modality which may be performed
rapidly, without radiation exposure, and at minimal cost. We hypothesized that transitioning
from CXR to US following TT removal in trauma patients would prove safe and provide
superior detection of residual PTX.
Materials and Methods
A practice management guideline was established calling for the performance of a CXR
and bedside US 2 h after TT removal in all adult trauma patients diagnosed with PTX
at a level 1 trauma center. Surgical interns completed a 30-minute, US training course
utilizing a handheld US device. US findings were interpreted and documented by the
surgical interns. CXRs were interpreted by staff radiologists blinded to US findings.
Data was retrospectively collected and analyzed.
Results
Eighty-nine patients met inclusion criteria. Thirteen (15%) post removal PTX were
identified on both US and CXR. An additional 11 (12%) PTX were identified on CXR,
and 5 (6%) were identified via US, for a total of 29 PTX (33%). One patient required
re-intervention; the recurrent PTX was detected by both US and CXR. For all patients,
using CXR as the standard, US displayed a sensitivity of 54.2%, specificity of 92.3%,
negative predictive value of 84.5%, and positive predictive value of 72.2%. The cost
of care for the study cohort may have been reduced over $9,000 should US alone have
been employed.
Conclusion
Bedside US may be an acceptable alternative to CXR to assess for recurrent PTX following
trauma TT removal.
Keywords
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Article info
Publication history
Published online: September 17, 2022
Accepted:
September 16,
2022
Footnotes
Meeting Presentation: 35th EAST Annual Scientific Assembly. January 12, 2022. Austin, TX.
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
