■为了评估小儿气管切开置管后订购胸部X光片在识别急性,术后并发症及其对临床决策的影响.
■在这项回顾性队列研究中,在2013年至2018年的5年期间,我们通过CPT编码对139例儿科患者进行了气管切开术.对人口统计学和临床特征进行手动图表审查,术前和术后胸部X光解释,和并发症的存在。对每个并发症进行审查,以查看是否由于术后胸部X射线检查结果而采取行动。进行多变量逻辑回归以确定与手术前和手术后胸部X线变化的关联。
■在一组139名接受术前和术后胸部X光检查的儿科患者中,与术前胸部X线检查结果相比,40例(28.8%)患者的术后胸部X线检查结果新。在这40例术前与术后胸部X光检查结果的变化中,由于观察到的发现,只有8项导致采取行动。在采取的八种行动中,只有一例涉及支气管镜检查的侵入性行动。通过多元回归分析,患者年龄,种族,性别,以及遗传综合征的存在,未发现预测术前与术后胸部X线变化的显著危险因素。
■在我们的研究中,气管切开置管后的术后胸部X线检查对临床决策没有显著影响.值得重新考虑小儿气管切开插管后常规胸部X光检查的价值。
UNASSIGNED: To evaluate the utility of ordering chest x-rays after pediatric tracheostomy tube placement in identifying acute, post-operative complications and how it impacts clinical decision-making.
UNASSIGNED: In this retrospective cohort study, we identified tracheostomies performed in 139 pediatric patients through CPT codes over a 5-year period from 2013 to 2018. Manual chart review was performed for demographic and clinical characteristics, pre-procedure and post-procedure chest x-ray interpretations, and the presence of complications. Each complication was reviewed to see if action was taken due to post-procedure chest x-ray findings. Multivariable logistic regression was performed to determine associations with changes in pre-procedure versus post-procedure chest x-rays.
UNASSIGNED: In a cohort of 139 pediatric patients with pre-procedure and post-procedure chest x-rays, 40 (28.8%) of patients had new significant post-procedure chest x-ray findings compared to pre-procedure chest x-ray findings. Of these 40 instances of changes in pre-procedure versus post-procedure chest x-ray findings, only eight resulted in action being taken due to the observed findings. Among these eight instances of action being taken, only one instance involved in invasive action being taken with a bronchoscopy. With multivariable regression analysis, patient age, race, gender, and the presences of genetic syndromes, were not found to be significant risk factors in predicting changes in pre-procedure versus post-procedure chest x-ray.
UNASSIGNED: In our study, post-procedure chest x-ray after tracheostomy tube placement did not significantly impact clinical decision making. It may be worth reconsidering the value in routine chest x-rays after tracheostomy tube placement in pediatric patients.