C. Crayton1, J. Robbins1, L. Hahn1, J. Miner1 1Wright State University, Department Of Surgery, Dayton, OH, USA
Introduction:
The removal of thoracostomy tubes has a 2-3% risk of post-pull pneumothorax requiring immediate chest tube replacement. Screening for pneumothorax is standard practice after chest tube removal, with post-pull chest X-ray being the gold standard for evaluation. However, studies have shown that thoracic ultrasound is effective at detecting pneumothorax and may be a viable alternative to X-ray with multiple associated benefits. This study aims to evaluate the safety and efficacy of ultrasound for evaluation of clinically significant post-pull pneumothorax compared to X-ray.
Methods:
We performed a prospective cohort study at a Level 1 trauma center between April and December 2022 comparing the ability of thoracic ultrasound to detect clinically significant post-pull pneumothorax compared with chest X-ray. Patients with chest tubes placed for pneumothorax, hemothorax, or hemopneumothorax were included. Thoracic ultrasound was performed and interpreted by practitioners trained in this technique and compared to the results of chest X-rays interpreted by radiologists. Clinically insignificant pneumothorax was defined as a small residual or apical pneumothorax without associated respiratory symptoms or need for chest tube replacement.
Results:
We included 82 patients, the most common etiology was blunt trauma (n= 57), and the indications for chest tube placement were: pneumothorax (n= 38), hemothorax (n=15), and hemopneumothorax (n=14). The majority, 98% (80/82) of ultrasound exams were performed within 15 minutes of chest tube removal, and X-rays were obtained thereafter. One patient required chest tube replacement for recurrent pneumothorax identified by both ultrasound and X-ray. Thoracic ultrasound, by comparison to chest X-ray, had a sensitivity of 100%, specificity of 95%, PPV of 60%, and NPV of 100% for the detection of clinically significant post-pull pneumothorax.
Conclusion:
The use of thoracic ultrasound for the detection of clinically significant pneumothorax after the removal of thoracostomy tubes is a safe and effective alternative to standard chest X-ray. This echoes similar studies and indicates changes to the gold standard could occur with further multicenter studies.