Comparative study of the need for re-intervention after chest tube remove in two groups with and without chest x-ray in Patients Admitted into Razi and Poursina hospital in Rasht city

Abstract

Introduction: The most common types of injuries following blunt or sharp trauma of lungs and the pleural space are pneumothorax, hemothorax and hemopneumothorax, which in most cases are resolved through supportive care and thoracostomy (use of chest tubes). Removal of the CT (chest tube) can result in complication such as pneumothorax and accumulation of fluid in the pleural space. Despite the lack of a standard guideline regarding the management of patients post CT removal, it is advised to procure a CXR as a means of a conservative approach. However, most of the findings acquired from the post CT removal CXR are not clinically significant and in the case of patients requiring intervention, there are almost always clinical signs and symptoms present. Considering the prior statements, the lack of a standard guideline even in the general and thoracic surgery references, show cases the importance of this study. This study is set upon proving that, the omission of post CT removal CXR in asymptomatic patients will not have an impact on the clinical outcome of the case and will reduce the costs as well as the patients' exposure to radiation and hospital stay. Methods: This study is designed as cross-sectional study with a sample size of 200 patients who were hospitalized for CT insertion in the Surgery clinic of Razi and Poursina Hospitals in Rasht between 21/4/2019 and 20/4/2020 and matched our entry criteria. The patients were divided into 2 groups of 100, with one group being monitored without CXR and the other with the use of CXR. Some forms were designed as checklists for the task of data collection. The data analysis was done through Fisher's exact test, Chi square test and Mann Whitney U test. In addition, the Significance level was set at 0.05 (p value ≤ 0.05). Result: Out of the 200 patients included in our study, 120 were male (60%) and the rest (40%) were female. The most common underlying disease in both groups (with and without CXR) of our study was Hip fracture. In both groups, The most frequent reason for CT insertion was pleural effusion (36% and 43% in with CXR and without CXR groups respectively), but the difference between the 2 groups was not statistically significant (p = 0.597). In most of the cases, 1 CT was inserted and there was no statistically significant difference between the 2 groups. The difference between the 2 groups regarding the need for intervention (11 cases in the CXR group and 6 cases in the Non CXR group) was also statistically insignificant. The duration of hospital stay did not show a statistically significant difference between the 2 groups (p = 0.644). Conclusion: Our study suggests that whether a post CT removal CXR is obtained or not, will not make a statistically significant difference in the number of interventions, the cause of intervention, and the number of inserted CTs and the duration of hospital stay. Therefore, it can be suggested that the need for reintervention in post CT removal patients can be determined through clinical signs, symptoms and the surgeon's judgment, without the need for a routine CXR.