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Are routine chest X-rays required after removal of chest drains in children?
  1. Alexandra Richards1,
  2. Jordan Evans2
  1. 1 Cardiff University School of Medicine, Cardiff, UK
  2. 2 Paediatric Emergency Department, Cardiff and Vale University Health Board, Cardiff, UK
  1. Correspondence to Alexandra Richards, Cardiff University School of Medicine, Cardiff CF14 4YS, UK; richardsae4{at}

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A 2-year-old girl is admitted to the paediatric critical care unit following a traumatic pneumothorax as a result of a road traffic collision. After a few days, the chest drain is removed, and she is transferred to the ward for further observation. You clerk the patient on admission to the paediatric ward and are pleased to note that she is well, with no signs of respiratory distress and all observations within normal limits for her age. A senior colleague requests that you arrange a chest X-ray (CXR) to ensure that the pneumothorax has resolved. You question the importance of this investigation in an asymptomatic child.

Structured clinical question

Following chest drain removal in children (patient), does routine chest radiography (intervention) assist in monitoring or change the management of asymptomatic patients (outcome)?


In December 2019, we searched Embase (1946–present) and MEDLINE (1946–present) databases using the OVID search interface. Our search terms included: (chest x-ray OR chest radiograph) AND (chest drain OR chest tube OR thoracostomy tube) AND (removal OR withdrawal) AND (children OR paediatrics OR adolescents OR infants). We identified 98 articles, written in English language, which were reviewed further; case reports and conference abstracts were excluded. A further search of the Cochrane Library was performed using the same search terms, which identified 14 clinical trials; however, none of these trials were appropriate for our clinical question. A total of 6 relevant studies were identified as described in table 1. The level of evidence was classified according to Oxford …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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