Elsevier

Mayo Clinic Proceedings

Volume 73, Issue 10, October 1998, Pages 948-950
Mayo Clinic Proceedings

Original Article
Chest Roentgenography After Outpatient Thoracentesis

https://doi.org/10.4065/73.10.948Get rights and content

Objective

To evaluate the clinical utility of posteroanterior chest roentgenograms after thoracentesis in the outpatient setting.

Design

We undertook a retrospective study of clinical records of outpatient thoracenteses performed between January and December 1996 by the Division of Pulmonary and Critical Care Medicine at Mayo Clinic Rochester.

Material and Methods

The medical records of 54 men and 39 women who underwent 123 outpatient thoracenteses were reviewed. Exclusion criteria were the need for pleural biopsy at time of thoracentesis or the need for ultrasound-guided assistance for completion of the procedure. Indications for thoracentesis and postthoracentesis chest roentgenography were analyzed.

Results

Of 123 thoracenteses performed in the outpatient setting during the specified study period, 104 met the inclusion criteria. Of these 104 thoracenteses, 54 (52%) were followed by chest roentgenography. Pneumothorax occurred in only 5 of these 104 procedures (5%), in 5 separate patients. Three of these patients were asymptomatic and did not require therapeutic intervention; the two symptomatic patients required hospitalization and chest tube drainage. Of the two pneumothoraces in patients with symptoms, one was detected on the same day as the thoracentesis, and the other was diagnosed 2 days later. The patients who did not undergo postthoracentesis chest roentgenography had no reported complications. Of the 54 chest roentgenograms, 52 were obtained in asymptomatic patients, with no suspicion of pneumothorax. These x-ray studies led to a total cost of $4,862 and detection of three pneumothoraces that did not require therapy.

Conclusion

Routine performance of chest roentgen- ography after outpatient thoracentesis can incur substantial cost. A more selective approach to this practice is needed, both to optimize patient care and to manage limited medical resources efficiently. Postthoracentesis chest roentgenograms should be limited to patients with symptoms indicative of thoracentesis-induced pneumothorax.

Section snippets

Methods

We reviewed the medical records of all patients who underwent outpatient thoracentesis in the Division of Pulmonary and Critical Care Medicine at Mayo Clinic Rochester from January through December 1996. Either pulmonary consultants or clinical fellows under the direct supervision of staff consultants performed all procedures. All procedures used a standard thoracentesis kit with a 14-gauge needle. Patients excluded from the study were those who required ultrasound guidance for completion of

Results

Our review documented that, of the 123 outpatient thoracenteses performed during 1996, 104 thoracenteses performed in 93 patients fulfilled our criteria for inclusion in the study. This study population included 54 men (mean age, 65.3 ± 15.2 years) and 39 women (mean age, 66.2 ± 14.4 years). Ten patients underwent multiple thoracenteses, all of which were performed on different days.

Of the 104 thoracenteses, 54 were followed by chest roentgenography. Five of the 104 procedures (5%) resulted in

Discussion

Several publications have assessed the need for postthoracentesis chest roentgenography. A study by Doyle and coworkers' identified an inpatient population that, by meeting certain clinical criteria, may be at low risk for having a pneumothorax (see subsequent discussion). Previous studies, all of which focused on hospital patients, have reached similar conclusions that imply the reduced need for postthoracentesis chest roentgenography. These opinions are based on the relatively low incidence

Conclusion

We conclude that if the clinical suspicion of a postthoracentesis pneumothorax is low, the routine use of postthoracentesis chest roentgenography simply to identify a clinically significant pneumothorax is unjustified. Furthermore, as medical resources become more limited, critical assessment of patients who may require postthoracentesis chest roentgenograms will be a cost-effective approach. In our study, 52 of 54 postthoracentesis chest roentgenograms were obtained in asymptomatic patients,

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