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Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons
56th Annual Meeting Abstracts


Chest Radiography After Tracheostomy: Is There A Benefit?
William Tobler, MD, Juan Melia, MD, Joanna Ng, MD, Anand Selyam, MD, Peter Burke, MD, FACS, Suresh Agarwal, MD, FACS
Boston Medical Center, Boston, MA

PURPOSE OF STUDY

Routine Chest X-Ray (CXR) after tracheostomy remains a widely accepted practice despite lack of evidence supporting clinical utility. We examine whether establishment of a policy utilizing clinical exam after tracheostomy will reduce cost and minimize patient exposure to radiation.

 

METHODS USED

A retrospective review of all tracheostomy at a trauma intensive care unit over a 5 year period was performed. Preoperative and postoperative CXR and chart documentation were evaluated to determine clinical significance. Significant findings on CXR included new pneumothorax/subcutaneous emphysema or an increase in consolidation or effusion. The cost of portable CXR was estimated to be $500 per event.

SUMMARY OF RESULTS

A total of 255 tracheostomies were included: 131 open tracheostomies (105 male, 26 female) and 112 percutaneous tracheostomies (93 male and 19 females) and 22 patients were excluded due to inadequate documentation. Age ranged from 12-93 years. Procedures were performed from hospital day 1 to day 46. Indications included respiratory failure (214) and traumatic brain or spinal cord injury (41). Positive findings were found on 7 CXR after the procedure: 6 patients were managed prior to CXR based on clinical presentation, and the 7th patient was observed for a deep sulcus sign which resolved spontaneously. An additional 4 patients had worsening clinical picture without change in CXR. The remaining 244 patients (95.6%) had no change in CXR after the procedure and a stable clinical picture. A cost savings of $122,000 could have been realized if a protocol utilizing clinical exam been utilized.

 

CONCLUSIONS

Routine CXR following tracheostomy fails to provide additional information above clinical examination. Clinical deterioration should be the stimulus for radiographic examination. Such a protocol can result in significant cost savings and minimize patient exposure to radiation.

 


 

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