Optimal timing of chest radiograph following chest tube removal in detecting recurrent pneumothorax: analysis of 163 patients with thoracic stab wounds at a major trauma centre in South Africa.

Abstract

Introduction: Routine chest radiograph (CXR) following chest tube removal is a common practice, yet the optimal timing of CXR in detecting recurrent pneumothorax (RPTX) remains unknown. This study reviewed the incidence of RPTX and its relationship to the timing of the detection of CXR.

Methods: A prospective study was conducted over a 24-month period on patients with thoracic stab wounds who underwent CXR following chest tube removal at a major trauma centre in South Africa.

Results: One hundred and sixty-three patients were included (91% male, mean age: 25 years). Eleven patients (7%) had RPTX, one (9%) of whom required reinsertion of a chest tube. No patients were readmitted following discharge. The timing of the CXR was: <2h (11%), 2-4h (21%), 4-6h (28%), 6-8h (31%) and >8h (9%). Of the 11 RPTX, 55% were detected on CXR at <2h, 36% at 2-4h, 9% at 4-6h, 0% at 6-8h (0%) and 0% at >8h. All RPTX were detected within <6h of chest tube removal. There was no re-presentation of any patients following discharge.

Conclusion: RPTX following chest tube removal is uncommon, and the need for reintervention is low. All patients with RPTX were detected on CXR obtained within 6h of removal. It would appear that routinely delaying CXR anytime beyond 6 hours is unnecessary.