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KMID : 0385920160270050396
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Journal of the Korean Society of Emergency Medicine
2016 Volume.27 No. 5 p.396 ~ p.403
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Evaluation of the Optimal Site and Needle Length of Needle Thoracostomy in Chest Trauma Patients
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Kong Min-Gyu
Kim Hyun-Jong
Park Jun-Seok
Kim Kyung-Hwan
Shin Dong-Wun
Kim Hoon
Park Joon-Min
Jeon Woo-Chan
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Abstract
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Purpose: Tension pneumothorax is a life threatening condition. As an emergency treatment, needle thoracostomy with 50mm angiocatheter at the second intercostal space on the mid-clavicular line (2nd ICS/MCL) is recommended in the current guidelines. However, another site has been suggested in some studies. The purpose of this study was to determine whether the current procedure should be changed, by comparing the chest wall thicknesses (CWT) at the 2nd ICS/MCL and the 5th ICS/AAL (anterior axillary line) of injured patients.
Method: A retrospective observational study was performed in an emergency center between May 2009 and December 2011. Medical records and computed tomography (CT) images of 140 included patients were reviewed. CWT at the 2nd ICS/MCL was compared with the 5th ICS/AAL. Moreover, the relationship between BMI (body mass index) and CWT was evaluated.
Results: CWT of the 2nd ICS/MCL was 31.7±8.5 mm on the right and 31.6±8.8 mm on the left, with no differences (p=0.42). CWT of the 5th ICS/AAL was 28.1±8.5 mm on the right and 27.8±7.7 mm on the left, also with no differences (p=0.30). CWT of the 2nd ICS/MCL was thicker than that of the 5th ICS/AAL (p<0.001). Nevertheless, CWT of all sites were not thicker than 50 mm (p<0.001). BMI was positively correlated with CWT.
Conclusion: There was insufficient amount of evidences shown in this study to change the current guidelines of needle thoracostomy. However, in case of obvious patients, a long needle and 5th ICS/AAL site should be considered for needle thoracostomy, because CWT tended to increase as BMI increased.
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KEYWORD
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Chest injury, Needle thoracostomy, Tension pneumothorax
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