Clinical Characteristics of Patients Undergoing Needle Thoracostomy in a Canadian Helicopter Emergency Medical Service

Newton, Graham; Reay, Gudrun; Laing, Catherine M.; King‐Shier, Kathryn

doi:10.1080/10903127.2021.1912226

Cited by 2 publications

(4 citation statements)

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“…Our rates of PHND were similar to those of prior work, ranging from 0.2% to 1.7% of trauma patients, depending on the population studied . The presence of hypotension before PHND varied widely from 7.9% to 86%; however, most studies report prehospital hypotension rates between 25% and 50%, more in line with the third of patients with prehospital hypotension reported here.…”

Section: Discussionsupporting

confidence: 88%

“…Many prior studies report on clinical improvement after PHND and technical success rates of pleural cavity decompression. Clinical improvement rates vary considerably between studies, ranging from 5.7% to 53% after PHND . Several studies reported that improvements in dyspnea and hypoxia were more common than improvement in hemodynamic parameters, although patients with hypotension have a 3-fold higher odds of having improvement in blood pressure than patients without hypotension before PHND .…”

Section: Discussionmentioning

confidence: 81%

“…Clinical improvement rates vary considerably between studies, ranging from 5.7% to 53% after PHND. 7,10,16,18,19 Several studies reported that improvements in dyspnea and hypoxia were more common than improvement in hemodynamic parameters, 7,10,18 although patients with hypotension have a 3-fold higher odds of having improvement in blood pressure than patients without hypotension before PHND. 16 We found comparable rates of physiologic improvement after PHND, with one-third of patients having at least 1 physiologic abnormality improving.…”

Section: Discussionmentioning

confidence: 99%

“…7,10,16,18,19 Several studies reported that improvements in dyspnea and hypoxia were more common than improvement in hemodynamic parameters, 7,10,18 although patients with hypotension have a 3-fold higher odds of having improvement in blood pressure than patients without hypotension before PHND. 16 We found comparable rates of physiologic improvement after PHND, with one-third of patients having at least 1 physiologic abnormality improving. Success of pleural decompression is also highly variable, ranging from 5.9% to 100% with a bimodal distribution of mostly greater than 80% or less than 25% success rates among studies.…”

Section: Discussionmentioning

confidence: 99%

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Association of Prehospital Needle Decompression With Mortality Among Injured Patients Requiring Emergency Chest Decompression

et al. 2022

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ImportancePrehospital needle decompression (PHND) is a rare but potentially life-saving procedure. Prior studies on chest decompression in trauma patients have been small, limited to single institutions or emergency medical services (EMS) agencies, and lacked appropriate comparator groups, making the effectiveness of this intervention uncertain.ObjectiveTo determine the association of PHND with early mortality in patients requiring emergent chest decompression.Design, Setting, and ParticipantsThis was a retrospective cohort study conducted from January 1, 2000, to March 18, 2020, using the Pennsylvania Trauma Outcomes Study database. Patients older than 15 years who were transported from the scene of injury were included in the analysis. Data were analyzed between April 28, 2021, and September 18, 2021.ExposuresPatients without PHND but undergoing tube thoracostomy within 15 minutes of arrival at the trauma center were the comparison group that may have benefited from PHND.Main Outcomes and MeasuresMixed-effect logistic regression was used to determine the variability in PHND between patient and EMS agency factors, as well as the association between risk-adjusted 24-hour mortality and PHND, accounting for clustering by center and year. Propensity score matching, instrumental variable analysis using EMS agency-level PHND proportion, and several sensitivity analyses were performed to address potential bias.ResultsA total of 8469 patients were included in this study; 1337 patients (11%) had PHND (median [IQR] age, 37 [25-52] years; 1096 male patients [82.0%]), and 7132 patients (84.2%) had emergent tube thoracostomy (median [IQR] age, 32 [23-48] years; 6083 male patients [85.3%]). PHND rates were stable over the study period between 0.2% and 0.5%. Patient factors accounted for 43% of the variation in PHND rates, whereas EMS agency accounted for 57% of the variation. PHND was associated with a 25% decrease in odds of 24-hour mortality (odds ratio [OR], 0.75; 95% CI, 0.61-0.94; P = .01). Similar results were found in patients who survived their ED stay (OR, 0.68; 95% CI, 0.52-0.89; P &lt; .01), excluding severe traumatic brain injury (OR, 0.65; 95% CI, 0.45-0.95; P = .03), and restricted to patients with severe chest injury (OR, 0.72; 95% CI, 0.55-0.93; P = .01). PHND was also associated with lower odds of 24-hour mortality after propensity matching (OR, 0.79; 95% CI, 0.62-0.98; P = .04) when restricting matches to the same EMS agency (OR, 0.74; 95% CI, 0.56-0.99; P = .04) and in instrumental variable probit regression (coefficient, −0.60; 95% CI, –1.04 to –0.16; P &lt; .01).Conclusions and RelevanceIn this cohort study, PHND was associated with lower 24-hour mortality compared with emergent trauma center chest tube placement in trauma patients. Although performed rarely, PHND can be a life-saving intervention and should be reinforced in EMS education for appropriately selected trauma patients.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 81%