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Chest Trauma

Date Last Search Run: Feb 01, 2022
Table last updated: Apr 02, 2022
Data last added: Apr 27, 2022

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)      
2 (fair evidence exists)  
3 (weak evidence exists)      


Interventions

3 Sided/Occlusive Dressing
Level Direction Primary Outcome Patient/Process Setting Reference

Bougie-assisted Chest Tubes (CCT)
Level Direction Primary Outcome Patient/Process Setting Reference

Chest Tube (CCT)
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Survival Patient PH-Paramedic Huber-Wagner S., et al. Outcome of 757 severely injured patients with traumatic cardiorespiratory arrest. Resus 2007; 75:276-85. Medline
II Neutral (Yellow) Improvement in clinical status Patient Barton ED., Epperson M., Hoyt DB., et al. Prehospital needle aspiration and tube thoracostomy in trauma victims: A six-year experience with aeromedical crews. J Emerg Med 1995; 13(2):155-63. Medline
II Neutral (Yellow) Multi-organ failure rate Patient PH-Paramedic Regel G., Stalp M., Lehmann U., Seekamp A. Prehospital care, importance of early intervention on outcome. Acta Anaesthesiol Scand Suppl 1997; 110:71-6. Medline
III Supportive (Green) Improved vital signs Process ED-MD Coats TJ., Wilson AW., Xeropotamous N. Pre-hospital management of patients with severe thoracic injury. Injury: International J of the Care of the Injured 1995; 26(9):581-5. Medline
III Supportive (Green) Safety and efficacy Patient Schmidt U., Stalp M., Gerich T., et al. Chest tube decompression of blunt chest injuries by physicians in the field: Effectiveness and complications. J Trauma 1998; 44(1):98-101. Medline
III Neutral (Yellow) Mortality Patient ED-MD Davis DP., Pettit K., Rom CD., et al. The safety and efficacy of prehospital needle and tube thoracostomy by aeromedical personnel. Prehosp Emerg Care 2005; 9(2):191-7. Medline
III Neutral (Yellow) correct performance of intervention Patient PH-Paramedic Lairet JR., Bebarta VS., Burns CJ., Lairet KF., Rasmussen TE., Renz EM., et al. Prehospital interventions performed in a combat zone: a prospective multicenter study of 1,003 combat wounded. J Trauma Acute Care Surg 2012; 73(2S1):S38-42. Medline
III Neutral (Yellow) The primary objective of this study was to compare the infectious complication rate between emergency department (ED) and prehospital TT. Patient Spanjersberg WR., Ringburg AN., Bergs EA., Krijen P., Schipper IB. Prehospital chest tube thoracostomy: Effective treatment or additional trauma? J Trauma 2005; 59(1):96-101. Medline
III Opposes (Red) Appropriateness Process PH-MD & CCT Aylwin CJ., Brohi K., Davies GD., Walsh M. Pre-hospital and in-hospital thoracostomy: indications and complications. Ann R Coll Surg Eng 2008; 90:54-7. Medline

Needle Decompression
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Efficacy Patient Aho JM., Thiels CA., El KM, et al. Needle thoracostomy: Clinical effectiveness is improved using a longer angiocatheter. The journal of trauma and acute care surgery 2016; 80(2):272-7. Medline
II Supportive (Green) Success Rate Process PH-Paramedic & CCT Robitaille-Fortin M, Norman S, Archer T, Mercier E. Prehospital Decompression of Pneumothorax: A Systematic Review of Recent Evidence. Prehosp Disaster Med 2021; 1–10. Medline
II Neutral (Yellow) Improvement in clinical status Patient Barton ED., Epperson M., Hoyt DB., et al. Prehospital needle aspiration and tube thoracostomy in trauma victims: A six-year experience with aeromedical crews. J Emerg Med 1995; 13(2):155-63. Medline
II Neutral (Yellow) Distance from pleural space Process PH-Paramedic & CCT Lesperance RN., Carroll CM., Aden JK., Young JB., Nunez TC. Failure Rate of Prehospital Needle Decompression for Tension Pneumothorax in Trauma Patients. Am Surg 2018; 84(11) 1750-5. Medline
II Neutral (Yellow) Mortality rate Patient PH-Paramedic Sharrock MK, Shannon B, Garcia Gonzalez C, St Clair T, Mitra B, Noonan M, et al. Prehospital paramedic pleural decompression: A systematic review. Injury 2021. Medline
II Neutral (Yellow) Efficacy Patient PH-Paramedic Waydhas C., Sauerland S. Pre-hospital pleural decompression and chest tube placement after blunt trauma: A systematic review. Resuscitation 2007; 72:11-15. Medline
III Supportive (Green) Survival Bushby N., Fitzgerald M., Cameron P., et al. Prehospital intubation and chest decompression is associated with unexpected survival in major thoracic blunt trauma. Emerg Med Australas 2005; 17(5-6):443-9. Medline
III Supportive (Green) Improvement in vital signs Patient PH-Paramedic & CCT Henry R, Ghafil C, Golden A, Matsushima K, Eckstein M, Foran CP, et al. Prehospital Needle Decompression Improves Clinical Outcomes in Helicopter Evacuation Patients With Multisystem Trauma: A Multicenter Study. J Spec Oper Med 2021; 21(1):49-54. Medline
III Supportive (Green) Dislodgement rate Process SIM Leatherman ML., Held JM., Fluke LM., McEvoy CS., Inaba K., Grabo D., et al. Relative device stability of anterior versus axillary needle decompression for tension pneumothorax during casualty movement Preliminary analysis of a human cadaver model. The journal of trauma and acute care surgery 2017; 83(1) S136-41. Medline
III Supportive (Green) Mortality Patient PH-Paramedic Sanson G., Di Bartolomeo S., Nardi G., et al. Road traffic accident with vehicular entrapment: incidence of major injuries and need for advanced life support. Eur J Emerg Med 1999; 6(4):285-91. Medline
III Supportive (Green) Mortality and morbidity Patient PH-Paramedic Warner KJ., Copass MK., Bulger EM. Paramedic use of needle thoracostomy in the prehospital environment. Prehosp Emerg Care 2008; 12:162-8. Medline
III Neutral (Yellow) First pass success Process PH-Paramedic Davis DP., Pettit K., Rom CD., et al. The safety and efficacy of prehospital needle and tube thoracostomy by aeromedical personnel. Prehosp Emerg Care 2005; 9(2):191-7. Medline
III Neutral (Yellow) Effect of needle thoracostomy (NT) Patient PH-Paramedic Eckstein M., Suyehara D. Needle thoracostomy in the prehospital setting. Prehosp Emerg Care 1998; 2:132-5. Medline
III Neutral (Yellow) Success Process Kaserer A., Stein P., Simmen HP., Spahn DR., Neuhaus V. Failure rate of prehospital chest decompression after severe thoracic trauma. Am J Emerg Med 2017; 35(3):469-74. Medline
III Neutral (Yellow) correct performance of intervention Patient PH-Paramedic Lairet JR., Bebarta VS., Burns CJ., Lairet KF., Rasmussen TE., Renz EM., et al. Prehospital interventions performed in a combat zone: a prospective multicenter study of 1,003 combat wounded. J Trauma Acute Care Surg 2012; 73(2S1):S38-42. Medline
III Neutral (Yellow) Proper needle thoracostomy placement Process PH-Paramedic Neeki MM, Cheung C, Dong F, Pham N, Shafer D, Neeki A, et al. Emergent needle thoracostomy in prehospital trauma patients: a review of procedural execution through computed tomography scans. Trauma Surg Acute Care Open 2021; 6(1):e000752. Medline
III Neutral (Yellow) Success rate Process ED-MD Stevens RL., et al. Needle thoracostomy for tension pneumothorax: failure predicted by chest CT. Prehosp Emerg Care 2009; 13:14-7. Medline
III Neutral (Yellow) Mortality Patient PH-Paramedic Weichenthal LA., Owen S., Stroh G., Ramos J. Needle Thoracostomy Does Changing Needle Length and Location Change Patient Outcome? Prehosp Disaster Med 2018; 33(3) 237-44. Medline
X Not Yet Graded (White) - Musa J, Zielinski M, Hernandez M, Mohan A, Traynor M, Mahony C, et al. Tension pneumothorax decompression with colorimetric capnography: pilot case series. Gen Thorac Cardiovasc Surg 2022; 70(1):59–63. Medline

Thoracostomy
Level Direction Primary Outcome Patient/Process Setting Reference

Ultrasound
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Detection of pneumothorax Process ED-MD Nagarsheth K., Kurek S. Ultrasound detection of pneumothorax compared with chest X-ray and computed tomography scan. Am Surg 2011; 77(4):480-4. Medline
II Supportive (Green) Prehospital U/S supported intervention. Patient PH-MD & CCT O'Dochartaigh D., Douma M., Alexiu C., Ryan S., MacKenzie M. Utilization Criteria for Prehospital Ultrasound in a Canadian Critical Care Helicopter Emergency Medical Service Determining Who Might Benefit. Prehosp Disaster Med 2017; 32(5) 536-40. Medline
II Supportive (Green) Feasibility Process PH-Paramedic Pietersen PI, Mikkelsen S, Lassen AT, Helmerik S, Jørgensen G, Nadim G, et al. Quality of focused thoracic ultrasound performed by emergency medical technicians and paramedics in a prehospital setting: a feasibility study. Scand J Trauma Resusc Emerg Med 2021; 29(1):40. Medline
II Supportive (Green) Detection of hemo/pneumothoraces Process ED-MD Staub LJ., Biscaro RRM., Kaszubowski E., Maurici R. Chest ultrasonography for the emergency diagnosis of traumatic pneumothorax and haemothorax A systematic review and meta-analysis. Injury 2018; 49(3) 457-66. Medline
II Neutral (Yellow) Feasibility Process PH-Paramedic & MD CB M, Ball M, RE C, MK R, Chrzan K, AR P. Ultrasound Use in the Prehospital Setting for Trauma: A Systematic Review. Prehosp Emerg Care 2021; 25(4):566–82. Medline
II Neutral (Yellow) Sensitivity and specificity Process ED-MD Matsushima K, Khor D, Berona K, Antoku D, Dollbaum R, Khan M, et al. Double Jeopardy in Penetrating Trauma: Get FAST, Get It Right. World J Surg 2018; 42(1):99-106. Medline
III Supportive (Green) Diagnosis of pericardial effusion Patient PH-Paramedic Heegarard W., et al. Prehospital ultrasound diagnosis of traumatic pericardial effusion. Acad Emerg Med 2009; 16(4):364. Medline
III Supportive (Green) Positive predictive value Patient Hoyer HX., Vogl S., Schiemann U., Haug A., Stolpe E., Michalski T. Prehospital ultrasound in emergency medicine: Incidence, feasibility, indications and diagnoses. Eur J Emerg Med 2010; 17(5):254-9 Medline
III Neutral (Yellow) Mortality Patient ED-MD Jorgensen H., Jensen CH., Dirks J. Does prehospital ultrasound improve treatment of the trauma patient? A systematic review. Eur J Emerg Med 2010; 17(5):249-53. Medline
III Neutral (Yellow) Detection of pneumothorax Process SIM Khalil PA, Merelman A, Riccio J, Peterson J, Shelton R, Meyers J, et al. Randomized Controlled Trial of Point-of-Care Ultrasound Education for the Recognition of Tension Pneumothorax by Paramedics in Prehospital Simulation. Prehosp Disaster Med 2021; 36(1):74-8. Medline
III Neutral (Yellow) Accuracy Process PH-Paramedic Press GM, Miller SK, Hassan IA, Alade KH, Camp E, Junco DD, Holcomb JB. Prospective evaluation of prehospital trauma ultrasound during aeromedical transport. J Emerg Med. 2014;47(6):638-45 Medline
X Not Yet Graded (White) - Griffiths E. Helicopter emergency medical services use of thoracic point of care ultrasound for pneumothorax: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med 2021; 29(1):163. Medline
X Not Yet Graded (White) - Santorelli JE, Chau H, Godat L, Casola G, Doucet JJ, Costantini TW. Not so FAST-Chest ultrasound underdiagnoses traumatic pneumothorax. J Trauma Acute Care Surg 2022; 92(1):44–8. Medline


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