Chest
Clinical InvestigationsPLEURALimited Utility of Chest Radiograph After Thoracentesis
Section snippets
Materials and Methods
Subsequent to approval by the institutional review board, all patients having thoracentesis performed in the treatment area from October 1995 until January 1998 were prospectively enrolled. As this study constituted comparison of two accepted regimens (process research), consent was not required, and the study was transparent to the physicians and patients. Exclusion criteria included thoracentesis outside the treatment room, concomitant tube thoracostomy, or positive-pressure ventilation.
The
Results
A total of 278 thoracenteses were performed on 218 patients. Complete data allowed for evaluation of 251 procedures on 199 patients. Those data were evaluated to assess the utility of the CXR. The physician declined to complete the questionnaire for 27 procedures performed on 25 patients; because of multiple procedures, six patients appear in both groups. The data on the 27 procedures are only included in the determination of overall rates of complications and associated risk factors. No
Discussion
This study represents the first prospective evaluation of the role of immediate CXR after thoracentesis for both inpatients and outpatients. The overall rates of complication were similar to those of previously published series, as was the requirement for subsequent tube thoracostomy.4 The rate of pneumothorax was similar for experienced staff physician (9 of 142 procedures, 6.3%) and the fellows (5 of 99 procedures, 5.0%) but was slightly higher for the residents/medical students (4 of 37
Conclusion
In the absence of suspicion or clinical indication of a complication, chest radiography immediately after thoracentesis is not warranted in the vast majority of cases either for the identification of pneumothorax or detection of new diagnostic information. This is independent of the intention (diagnostic or therapeutic) of the thoracentesis. The use of a vacuum bottle to withdraw fluid negates this finding and increases the risk of complication. The use of such vacuum devices to withdraw
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