Prehospital chest tube thoracostomy: effective treatment or additional trauma?
BACKGROUND
The use of prehospital chest tube thoracostomy (TT) remains controversial because of presumed increased complication risks. This study analyzed infectious complication rates for physician-performed prehospital and emergency department (ED) TT.


METHODS
Over a 40-month period, all consecutive trauma patients with TT performed by the flight physician at the accident scene were compared with all patients with TT performed in the emergency department. Bacterial cultures, blood samples, and thoracic radiographs were reviewed for TT-related infections.


RESULTS
Twenty-two patients received prehospital TTs and 101 patients received ED TTs. Infected hemithoraces related to TTs were found in 9% of those performed in the prehospital setting and 12% of ED-performed TTs (not significant).


CONCLUSIONS
The prehospital chest tube thoracostomy is a safe and lifesaving intervention, providing added value to prehospital trauma care when performed by a qualified physician. The infection rate for prehospital TT does not differ from ED TT.
Spanjersberg
Willem R
WR
Department of General Surgery and Traumatology, University of Rotterdam, Erasmus Medical Center, The Netherlands.
Spanjersberg
Willem
W
Ringburg
Akkie N
AN
Ringburg
Akkie
A
Bergs
Engelbert A
EA
Bergs
Bert
B
Krijen
Pita
P
Schipper
Inger B
IB
Schipper
Inger
I
Ringburg
A N
AN
Steyerberg
E W
EW
Edwards
M J
MJ
Schipper
I B
IB
van Vugt
A B
AB
D000328:Adult; D015505:Chest Tubes / Q000009:adverse effects; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology; D015601:Injury Severity Score; D008297:Male; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013898:Thoracic Injuries / Q000628:therapy*; D013907:Thoracostomy / Q000009:adverse effects / Q000379:methods*