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Chirurgie 6. August 2015

High correlation of lung ultrasound and chest X-ray after tube drainage in patients with primary spontaneous pneumothorax: can we omit X-rays for tube management?

Background: Primary spontaneous pneumothorax (PSP) is a common medical condition in the emergency department. Clinically stable patients with large pneumothoraces usually undergo chest tube drainage. During the course of hospital stay, several chest X-rays are ordered at various time points. Because the number of chest X-rays during diagnosis and management of PSP can be quite high and lung ultrasound has a proven efficacy for the assessment of lung re-expansion, we decided to investigate the use of lung ultrasound for the management and decision-making regarding chest drains for PSP.

Material and methods: A total of 25 patients with PSP were evaluated. A comparison between chest X-rays and lung ultrasound was made at four different time points during patient hospitalization (T1—immediately after drainage, T2–third or fourth post-drainage day, T3—before chest tube removal, T4—after chest tube removal). The rate of agreement between the two investigations was analyzed, as their result impacts decision-making regarding chest tube management and removal.

Results: Overall, positive and negative agreements were high in all time points, except time point 3. Calculatedpvalues using Fisher’s and Barnard’s test were also good for time points 1, 2, and 4 (< 0.05).

Conclusions: For all time points except the third, we can safely reject the null hypothesis, thereby arriving at the conclusion that lung ultrasound can substitute chest X-rays after tube drainage of PSP.

V. Constantin, A. C. Carap, L. Zaharia, S. Bobic, A. Ciudin, E. Brătilă, V. Vlădăreanu, B. Socea, European Surgery 4/2015

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