Original ArticleChest Roentgenography After Outpatient Thoracentesis
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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