BACKGROUND: It is routine to obtain a chest radiograph (CXR) after removal of a chest tube (CT) to assess for pneumothorax. Retrospective studies have shown that clinical signs were present in most children with pneumothorax and were an indication for a CXR. OBJECTIVE: Our objective was to determine if clinical indicators of pneumothorax are sufficient predictors of the need for CT reinsertion in children who have had a CT removed after cardiac surgery. METHODS: The prospective study included a physical assessment before CT removal, using a two-person technique, which was repeated 2 hours after CT removal. Based on assessment findings, a decision was made regarding whether a CXR was indicated. The routine CXR was then obtained and read by a pediatric intensivist who was blinded to the decision of the investigator. RESULTS: Sixty CTs were removed in 53 children. No false-positive predictions were made, because none of the children was predicted to have a pneumothorax requiring chest tube reinsertion, and none developed a significant pneumothorax (95% confidence interval: 0, 5%). CONCLUSIONS: The low rate of pneumothoraces in this study may be been related to how the CT was placed in surgery, the type of CT used, or the method of removal. In this study the risk of developing a pneumothorax requiring CT reinsertion after CT removal was at most 5% and therefore low enough to consider obtaining a CXR for symptomatic children only.
BACKGROUND: It is routine to obtain a chest radiograph (CXR) after removal of a chest tube (CT) to assess for pneumothorax. Retrospective studies have shown that clinical signs were present in most children with pneumothorax and were an indication for a CXR. OBJECTIVE: Our objective was to determine if clinical indicators of pneumothorax are sufficient predictors of the need for CT reinsertion in children who have had a CT removed after cardiac surgery. METHODS: The prospective study included a physical assessment before CT removal, using a two-person technique, which was repeated 2 hours after CT removal. Based on assessment findings, a decision was made regarding whether a CXR was indicated. The routine CXR was then obtained and read by a pediatric intensivist who was blinded to the decision of the investigator. RESULTS: Sixty CTs were removed in 53 children. No false-positive predictions were made, because none of the children was predicted to have a pneumothorax requiring chest tube reinsertion, and none developed a significant pneumothorax (95% confidence interval: 0, 5%). CONCLUSIONS: The low rate of pneumothoraces in this study may be been related to how the CT was placed in surgery, the type of CT used, or the method of removal. In this study the risk of developing a pneumothorax requiring CT reinsertion after CT removal was at most 5% and therefore low enough to consider obtaining a CXR for symptomatic children only.