Title

Is Routine Tube Thoracostomy Necessary after Prehospital Needle Decompression for Tension Pneumothorax?

Document Type

Presentation

Publication Date

3-2013

Abstract

Background

Thoracic needle decompression is lifesaving in tension pneumothorax. However, performance of subsequent tube thoracostomy is questioned. The needle may not enter the chest, or the diagnosis may be wrong. The aim of this study was to test the hypothesis that routine tube thoracostomy is not required.

Methods

A prospective 2-year study of patients aged ≥18 years with thoracic trauma was conducted at a level 1 trauma center.

Results

Forty-one patients with chest trauma, 12 penetrating and 29 blunt, had 47 needled hemithoraces for evaluation; 85% of hemithoraces required tube thoracostomy after needle decompression of the chest (34 of 41 patients [83%]).

Conclusions

Patients undergoing needle decompression who do not require placement of thoracostomy for clinical indications may be assessed using chest radiography, but thoracic computed tomography is more accurate. Air or blood on chest radiography or computed tomography of the chest is an indication for tube thoracostomy.

Comments

This is an Oral Presentation at the 55th Midwest Surgical Association meeting, Mackinac Island, Michigan.

DOI

10.1016/j.amjsurg.2013.01.004