Ultrasound may safely replace chest radiograph after tube thoracostomy removal in trauma patients |
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| Affiliation: | 1. Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN 37403, USA;2. University of Tennessee College of Medicine, 910 Madison Avenue, Suite 1031, Memphis, TN 38163, USA;3. Department of Orthopedic Surgery, University of Tennessee College of Medicine Chattanooga,979 East Third Street, Suite B-202, Chattanooga, TN 37403, USA;1. Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, CA, United States;2. Department of Radiology, Keck School of Medicine of the University of Southern California, CA, United States;1. Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (No.325, Sec.2, Chenggong Rd., Neihu District, Taipei City 11490, Taiwan (R.O.C));2. Department of Anesthesia, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (No.325, Sec.2, Chenggong Rd., Neihu District, Taipei City 11490, Taiwan (R.O.C));3. Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (No.325, Sec.2, Chenggong Rd., Neihu District, Taipei City 11490, Taiwan(R.O.C));4. Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan (No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City 11490, Taiwan (R.O.C.));1. School of Emergency Medicine, University of Turin;2. Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy;3. Department of Internal Medicine, Santa Croce e Carle Hospital, Cuneo, Italy;4. Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy;5. Physiotherapy Dept, Morriston Hospital, Swansea SA6 6NL, United Kingdom;6. Swansea Trials Unit, Swansea University, Swansea, SA2 8PP, United Kingdom;1. Greys Hospital, Department of Surgery, Pietermaritzburg Metropolitan, KwaZulu Natal, South Africa;2. Edendale Hospital, Department of Surgery, Pietermaritzburg Metropolitan, KwaZulu Natal, South Africa;3. University of KwaZulu Natal, KwaZulu Natal, South Africa;1. Medical School of Chinese PLA, Beijing, China;2. Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China;3. Xinxing Bridge Clinic, Southern Medical District of Chinese PLA General Hospital, Beijing, China |
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| Abstract: | IntroductionA 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 MethodsA 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.ResultsEighty-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.ConclusionBedside US may be an acceptable alternative to CXR to assess for recurrent PTX following trauma TT removal. |
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