title: Needle thoracostomy for tension pneumothorax: failure predicted by chest computed tomography.
abstract: OBJECTIVE
  Tension pneumothorax can lead to cardiovascular collapse and death. In the prehospital setting, needle thoracostomy for emergent decompression may be lifesaving. Taught throughout the United States to emergency medical technicians (EMTs) and physicians, the true efficacy of this procedure is unknown. Some question the utility of this procedure in the prehospital setting, doubting that the needle actually enters the pleural space. This study was designed to determine if needle decompression of a suspected tension pneumothorax would access the pleural cavity as predicted by chest computed tomography (CT).
  
  
  METHODS
  We retrospectively reviewed consecutive adult trauma patients admitted to a level I trauma center between January and March 2005. We measured chest wall depth at the second intercostal space, midclavicular line on CT scans. Data on chest wall thickness were compared with the standard 4.4-cm angiocatheter used for needle decompression.
  
  
  RESULTS
  Data from 110 patients were analyzed. The mean age of the patients was 43.5 years. The mean chest wall depth on the right was 4.5 cm (+/- 1.5 cm) and on the left was 4.1 cm (+/- 1.4 cm). Fifty-five of 110 patients had at least one side of the chest wall measuring greater than 4.4 cm.
  
  
  CONCLUSIONS
  The standard 4.4-cm angiocatheter is likely to be unsuccessful in 50% (95% confidence interval = 40.7-59.3%) of trauma patients on the basis of body habitus. In light of its low predicted success, the standard method for treatment of tension pneumothorax by prehospital personnel deserves further consideration.
authors.affiliation: F. H. Sammy Ross Jr. Trauma Center, Charlotte, North Carolina, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Stevens
authors.forename: Angel A
authors.initials: AA
authors.lastname: Rochester
authors.forename: Jonathan
authors.initials: J
authors.lastname: Busko
authors.forename: Thomas
authors.initials: T
authors.lastname: Blackwell
authors.forename: Daniel
authors.initials: D
authors.lastname: Schwartz
authors.forename: Anne
authors.initials: A
authors.lastname: Argenta
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Sing
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004635:Emergency Medicine / Q000193:education; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000601:surgery*; D035441:Thoracic Wall / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D013907:Thoracostomy / Q000009:adverse effects* / Q000379:methods* / Q000592:standards; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D055815:Young Adult