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Needle Thoracostomy for Patients with Prolonged Transport Times: A Case-control Study

Published online by Cambridge University Press:  08 July 2015

Lori Weichenthal ,
Desiree Hansen Crane ,
Luke Rond  and
Conal Roche
Lori Weichenthal*
Affiliation:
Department of Emergency Medicine, University of California San Francisco Fresno, Fresno, California USA
Desiree Hansen Crane
Affiliation:
Department of Emergency Medicine, University of California San Francisco Fresno, Fresno, California USA
Luke Rond
Affiliation:
Kingman Regional Medical Center, Kingman, Arizona USA
Conal Roche
Affiliation:
University of Cincinnati, Cincinnati, Ohio USA
*
Correspondence: Lori Weichenthal, MD, FACEP UCSF Fresno Department of Emergency Medicine 155 N. Fresno St. Suite 206 Fresno, California 93701 USA E-mail: lweichenthal@fresno.ucsf.edu
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Abstract

Introduction

The use of prehospital needle thoracostomy (NT) is controversial. Some studies support its use; however, concerns exist regarding misplacement, inappropriate patient selection, and iatrogenic injury. Even less is known about its efficacy in situations where there is a delay to definitive care.

Hypothesis/Aim

To determine any differences in survival of patients who underwent NT in the setting of prolonged versus short transport times, and to describe differences in mechanisms and complications between the two groups.

Methods

This was a retrospective, matched, case-control study of trauma patients in a four county Emergency Medical Service (EMS) system from April 1, 2007 through April 1, 2013. This system serves an urban, rural, and wilderness catchment area. A prehospital database was queried for all patients in whom NT was performed, identifying 182 patients. When these calls were limited to those with prolonged transport times, the search was narrowed to 32 cases. A matched control group, based on age and gender, with short transport times was then created as a comparison. Data collected from prehospital and hospital records included: demographics; mechanism of injury; call status; response to NT; and final outcome. Univariate and multivariate analyses were conducted, as appropriate, to assess the primary outcome of survival and to further elucidate the descriptive data.

Results

There was no difference in survival between the case and control groups, either when evaluated with univariate (34% vs 25%; P=.41) or multivariate (odds ratio=0.99; 95% CI, 0.96-1.02; P=.57) analyses. Blunt trauma was the most common mechanism in both groups, but penetrating trauma was more common in the control group (30% vs 9%; P=.003). Patients in the control group were also more likely to have no vital signs on initial assessment (62% vs 31%; P=.003). More patients in the case group were described as having clinical improvement after NT (34% vs 19%; P=.03). No complications of NT were reported in either group.

Conclusions

There was no significant difference in survival between patients with prolonged versus short transport times who underwent NT. Patients with prolonged transport times were more likely to have sustained blunt trauma, have vital signs on EMS arrival, and to have clinical improvement after NT.

WeichenthalL, CraneDH, RondL, RocheC. Needle Thoracostomy for Patients with Prolonged Transport Times: A Case-control Study. Prehosp Disaster Med. 2015;30(4):1–5.

Keywords

needle thoracostomytension pneumothoraxtrauma
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 30 , Issue 4 , August 2015 , pp. 397 - 401
Copyright
© World Association for Disaster and Emergency Medicine 2015 

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