Is routine chest radiography after ultrasonography-guided catheter thoracostomy necessary?

Many institutions still perform routine chest radiographs after tube thoracostomies despite current guidelines suggesting that this is not necessary for simple cases. We aimed to evaluate the usefulness of routine chest radiography following ultrasonography-guided catheter thoracostomies for the detection of complications of symptomatic pleural effusions in hospitalised patients. This was a retrospective review of 2,032 ultrasonography-guided thoracostomies on hospitalised patients with symptomatic effusions at a single institution from April 2012 to May 2015. The aetiology of effusions was not systemically registered, but patient demographics, procedural details and clinical outcomes were collected. Data was analysed using descriptive statistics and chi-square test. Generalised estimating equation analysis was performed to assess the relationship between chest radiography findings and complications, while controlling for age. Out of 2,032 chest radiographs performed, 92.96% (n = 1,889) were normal, 5.81% (n = 118) showed pneumothorax and 1.23% (n = 25) showed catheter kinking. 99 pneumothoraces and 24 kinked catheters were detected in the first hour post procedure. 97.40% (n = 115) of patients with pneumothorax were stable or had minor complication, such as vasovagal event. 0.20% (n = 4) of patients had serious complication post chest drain insertion, resulting in cardiovascular collapse. There was no significant relationship between chest radiography results and the occurrence of complications (p = 0.244). The amount of fluid drained or side of insertion did not affect the clinical outcome of patients. Routine use of chest radiography after tube thoracostomy did not significantly change patient management, which is concordant with recent guidelines. Instead, adverse clinical outcomes or procedural factors should guide investigations.