Impact of routine chest radiographs after removal of pigtail chest tubes placed by pediatric interventional radiology.

Abstract

Chest radiographs are commonly obtained after chest tube removal to assess for complications. The benefit of this practice in children is uncertain. To determine the clinical impact of a routine chest radiograph following removal of chest tubes placed by pediatric interventional radiology. This single-center retrospective study evaluated 200 chest tube removals in 176 patients (median age:4 years, interquartile range [IQR]:1.2-12; median weight: 17.2 kg, IQR: 10.67-37.6), whohad a chest tube placed and removed by pediatric interventional radiology over a 16-year period. A chest radiograph obtained on the day of removal was compared to the preceding study. For patients with imaging changes, medical records were reviewed to determine whether clinical actions occurred as a result. All records were reviewed for 7days after tube removal or hospital discharge, whichever occurred first. The most common indication for chest tube insertion was simple effusion (53%, 106/200) and the most common tube size was 10.2 French (38.7%, 81/209). The median tube dwell time was 8days (IQR: 5-17). There was a median of 14h (IQR: 7-33.5) between imaging before and after tube removal. Imaging changes occurred in 10% (n = 20/200) of chest tube removals. Three of 200 (1.5%) of these were symptomatic after removal and only 0.5% (1/200) required chest tube reinsertion. For the remaining removals resulting in chest radiograph changes, patients were asymptomatic and required no change in clinical management. For chest tubes placed by pediatric interventional radiology, these findings do not support the practice of a routine chest radiograph after removal in asymptomatic children.