title: Determination of the appropriate catheter length and place for needle thoracostomy by using computed tomography scans of pneumothorax patients.
abstract: BACKGROUND
  The primary goal of this study was to compare the chest wall thicknesses (CWT) at the 2nd intercostal space (ICS) at the mid-clavicular line (MCL) and 5th ICS at the mid-axillary line (MAL) in a population of patients with a CT confirmed pneumothorax (PTX). This result will help physicians to determine the optimum needle thoracostomy (NT) puncture site in patients with a PTX.
  
  
  METHODS
  All trauma patients who presented consecutively to A&E over a 12-month period were included. Among all the trauma patients with a chest CT (4204 patients), 160 were included in the final analysis. CWTs were measured at both sides and were compared in all subgroup of patients.
  
  
  RESULTS
  The average CWT for men on the 2nd ICS-MCL was 38mm and for women was 52mm; on the other hand, on the 5th ICS-MAL was 33mm for men and 38mm for women. On the 2nd ICS-MCL 17% of men and 48% of women; on the 5th ICS-MAL 13% of men and 33% of women would be inaccessible with a routine 5-cm catheter. Patients with trauma, subcutaneous emphysema and multiple rib fractures would have thicker CWT on the 2nd ICS-MCL. Patients with trauma, lung contusion, sternum fracture, subcutaneous emphysema and multiple rib fractures would have thicker CWT on the 5th ICS-MAL.
  
  
  CONCLUSIONS
  This study confirms that a 5.0-cm catheter would be unlikely to access the pleural space in at least 1/3 of female and 1/10 of male Turkish trauma patients, regardless of the puncture site. If NT is needed, the 5th ICS-MAL is a better option for a puncture site with thinner CWT.
authors.affiliation: Zonguldak Ataturk State Hospital, Department of Emergency Medicine, Zonguldak, Turkey. drhaldun@gmail.com
authors.forename: Haldun
authors.initials: H
authors.lastname: Akoglu
authors.forename: Ebru Unal
authors.initials: EU
authors.lastname: Akoglu
authors.forename: Serdar
authors.initials: S
authors.lastname: Evman
authors.forename: Tayfun
authors.initials: T
authors.lastname: Akoglu
authors.forename: Arzu Denizbasi
authors.initials: AD
authors.lastname: Altinok
authors.forename: Ozlem
authors.initials: O
authors.lastname: Guneysel
authors.forename: Ozge Ecmel
authors.initials: OE
authors.lastname: Onur
authors.forename: Serkan Emre
authors.initials: SE
authors.lastname: Eroglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057785:Catheters / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D035441:Thoracic Wall / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery; D013907:Thoracostomy / Q000295:instrumentation* / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014421:Turkey / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications; D055815:Young Adult
keywords: Chest wall thickness; Needle thoracostomy; Pneumothorax; Trauma; Tube thoracostomy