title: Is routine tube thoracostomy necessary after prehospital needle decompression for tension pneumothorax?
abstract: BACKGROUND
  Thoracic needle decompression is lifesaving in tension pneumothorax. However, performance of subsequent tube thoracostomy is questioned. The needle may not enter the chest, or the diagnosis may be wrong. The aim of this study was to test the hypothesis that routine tube thoracostomy is not required.
  
  
  METHODS
  A prospective 2-year study of patients aged ≥18 years with thoracic trauma was conducted at a level 1 trauma center.
  
  
  RESULTS
  Forty-one patients with chest trauma, 12 penetrating and 29 blunt, had 47 needled hemithoraces for evaluation; 85% of hemithoraces required tube thoracostomy after needle decompression of the chest (34 of 41 patients [83%]).
  
  
  CONCLUSIONS
  Patients undergoing needle decompression who do not require placement of thoracostomy for clinical indications may be assessed using chest radiography, but thoracic computed tomography is more accurate. Air or blood on chest radiography or computed tomography of the chest is an indication for tube thoracostomy.
authors: Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH 45409, USA.
authors: Kathleen M
authors: KM
authors: Dominguez
authors: A Peter
authors: AP
authors: Ekeh
authors: Kathryn M
authors: KM
authors: Tchorz
authors: Randy J
authors: RJ
authors: Woods
authors: Mbaga S
authors: MS
authors: Walusimbi
authors: Jonathan M
authors: JM
authors: Saxe
authors: Mary C
authors: MC
authors: McCarthy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015505:Chest Tubes; D019299:Decompression, Surgical / Q000295:instrumentation*; D004632:Emergency Medical Services; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D013902:Radiography, Thoracic; D013898:Thoracic Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D013907:Thoracostomy / Q000295:instrumentation* / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome