The value of chest radiography after chest tube removal in nonventilated trauma patients: a post-hoc analysis of a multicenter prospective cohort study

Abstract

Abstract Background Chest tubes are commonly placed in trauma care to treat life-threatening intrathoracic injuries by evacuating blood or air from the pleural cavity. Currently, it is common practice to routinely obtain chest radiographs between one to eight hours after chest tube removal, while the necessity of it has been questioned. This study describes the ‘ins-and-outs’ of chest tubes and evaluates the value of routine post-removal chest radiography in nonventilated trauma patients. Methods A post-hoc analysis of a multicenter observational prospective cohort study was performed in blunt chest trauma patients admitted with multiple rib fractures to two level-1 trauma centers between January 2018 and March 2021, and treated with one or more chest tubes. Exclusion criteria were mechanical ventilation during chest tube removal, missing reports of post-removal chest radiography, transfer to another hospital, or mortality before chest tube removal. Descriptive analyses were performed to calculate the number of findings on post-removal chest radiographs and reinterventions. Results A total of 207 patients were included for analysis of whom 14 underwent bilateral chest tube placement, resulting in 221 chest tube removals investigated in this study. The mean age was 58 ± 17 years, 71% were male, 73% were ASA 1 – 2, and the median ISS was 19 (IQR 14 – 29). In 68 out of 221 (31%) chest tube removals, post-removal chest radiography showed increased or recurrent intrathoracic pathology (i.e., 13% pneumothorax, 18% pleural fluid, and 8% atelectasis). Only two (3%) of these patients underwent a same-day reintervention based on these findings, of whom one had signs or symptoms of recurrent pathology, and one was asymptomatic. Conclusions It seems safe to omit routine use of post-removal chest radiography in nonventilated blunt chest trauma patients and to selectively use imaging in those patients presenting with clinical signs or symptoms after chest tube removal. Level of evidence Level II, Diagnostic Tests/Criteria