E. Lacy1,2, B. Platt1, W. Plants1, B. Griswold3, J. Hunt1, A. Marr1, J. Schoen1, L. Stuke1, A. A. Smith1, P. Greiffenstein1 1Louisiana State University Health Sciences Center, Surgery, New Orleans, LA, USA 2University Medical Center New Orleans, New Orleans, LOUISIANA, USA 3Tulane University School Of Medicine, New Orleans, LA, USA
Introduction:
Traumatic tension pneumothorax (TP) is a life-threatening condition that can lead to cardiac arrest. Needle decompression (ND) is a procedure performed to treat TP, often limited to the pre-hospital setting. Few studies have reviewed prehospital documentation and the application of protocols to determine if a ND was appropriate. The objective of this study was to determine if the broad signs and symptoms (s/s) of TP as dictated by local protocols and provider judgement are quality indicators of TP.
Methods:
Prehospital run reports on adult trauma patients who underwent NDs presenting to an urban Level 1 Trauma Center (TC) from January 2016 – December 2020 excluding cardiac arrest, SPB>90, HR<120, and/or RR<29. 85 cases were identified and presented to panels of EMS, Trauma Surgeons, and ED Physicians to evaluate for s/s and ND appropriateness based on EMS documentation.
Results:
1/85 cases had unanimous agreement that both s/s indicative of a TP were present and that a ND was an appropriate treatment (1.2%). Cases with >75% agreement (n=25, 29.4%) were compared to the cases with no agreement (n=60, 70.6%) A t-test of independent variables demonstrated that the cases with > 75% agreement had higher Injury Severity Scores (ISS) and New Injury Severity Scores (NISS) and were more likely to be deemed appropriate for the PHND procedure (p=0.013, p=0.007).
Conclusion:
This study found that there is a lack of consensus regarding the appropriateness of ND in the prehospital setting, however patients with higher ISS and NISS ratings are more likely to have agreement that a PHND is appropriate. The substantial lack of signs and symptoms for needle decompression, as well as the lack of congruence in analysis for appropriate conditions, make this topic suitable for the development of an organized Performance Improvement method. This supports the need for further studies to provide recommendations for the creation of guidelines for ND based on clinical findings present in patients with higher ISS and NISS.
