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Original Article

PAFMJ. 2017; 67(4): 641-645


CLINICAL ASSESSMENT COMPARED WITH CHEST-X-RAY AFTER REMOVAL OF CHEST TUBE TO DIAGNOSE PNEUMOTHORAX

Farhan Ahmed Majeed, Qamar-UL-Haq Noor, Umer Mehmood, Tashfeen Imtiaz, Usama Zafar.

Abstract
Objective: To evaluate clinical judgment in ruling out pneumothorax during the removal of the chest tube by auscultating the chest before removal and after the extubation of the chest tube in comparison to x ray radiological results.
Study Design: Descriptive cross sectional study.
Place and Duration of Study: Combined Military Hospital (CMH) Lahore Pakistan, from August 2015 to March 2016.
Material and Methods: A sample size of 100 was calculated. Patients were selected via non probability purposive sampling. Children under 14 years were not included. The patients with mal-positioned chest tube, surgical site infection, air leak and the patients with more than one chest tube on one side were excluded. A proforma was made and filled by one person. Chest tubes were removed by two trained senior registrars according to a protocol devised. It was ensured that there was no air leak present before removal clinically and radiologically. Another chest x-ray was done within 24 hours of extubation to detect any pathology that might have occurred during the process. Any complication in the patient clinically was observed till the x-ray film became available. Two sets of readings were obtained. Set A included auscultation findings and set B included x ray results.
Results: Out of 100 patients, 60 (60%) were males and 40 (40%) females. The ages of the patients ranged between 17-77 years. Mean age of the patient was 43.27 ± 17.05 years. In set A out of 100 (100%) no pneumothorax developed clinically. In set B out of 100 patients 99 (99%) showed no pneumothorax on chest x ray, only 1 (1%) showed pneumothorax which was not significant (less than 15% on X ray). However, the patient remained asymptomatic clinically and there was no need of reinsertion of the chest tube.
Conclusion: Auscultatory findings in diagnosing a significant pneumothorax are justified. Hence, if the chest tube is removed according to the protocol, clinically by auscultation we can be sure that no significant pneumothorax developed during extubation, thus there is no need of x-ray after wards.

Key words: Chest tube, Pneumothorax, X-ray.


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