Fields:

  • Data analytics
  • Emergency medicine
  • Health services
  • Medical image analysis
  • Primary care
  • Rural and Indigenous health
  • Surgery and subspecialties
  • Trauma and critical care

Location: Royal Brisbane and Women's Hospital

Type of student: Extra-curricular only

Type of work: 

  • Chart reviews
  • Literature review

Brief synopsis:

Finger thoracostomy is the preferred technique for decompression of the pleural space pre-hospital. It is considered more reliable than needle decompression, with confirmation of lung re-expansion able to be felt. The procedure is followed by intercostal catheter (ICC) insertion. In spontaneously-breathing patients, ICC insertion is required immediately to prevent pleural contamination. Patients who are positive pressure-ventilated can undergo this second step upon reaching hospital, reducing on-scene time and avoiding drainage system malfunction. In either case, the procedure is not risk-free, and may be complicated by massive haemorrhage, failure to decompress the pleural space, damage to underlying anatomy, and infection (empyema, cellulitis). 

Rates of reported complications vary. A meta-analysis in 2018(12) analysed 4891 ICC insertions over a 30 year period, with a overall complication of 19%. The authors noted variation in definitions and granularity of the included studies, as well as decreasing rates of infection as a complication. One recent Australian retrospective cohort study(13) reviewed 103 patients managed in the pre-hospital environment over a 3-year period. Of survivors, the most common complication was injuries to surrounding structures (3.2%), followed by cellulitis (1.6%). There were no recorded cases of empyema. A retrospective review(14) of 250 patients managed with finger or tube thoracotomy in the aeromedical environment reported an overall complication rate of 3.4%, which included tube dislodgement and empyema. 

Objectives:

To examine the outcomes of pre-hospital thoracostomies in patients being received at two Major Trauma Centres in Brisbane, Queensland. 

Methods:

Collation of anonymised data over a 36-month period from PAH and RBWH Emergency Departments and Trauma Services. Correlation of this data with Lifeflight Retrieval Medicine records to maximise capture. Data is to contain basic demographic information (age, sex), indication for thoracostomy procedure (mechanism of injury, clinical signs, sonographic signs), procedure performed, time of procedure, time of arrival at hospital destination, physiological parameters pre- and post- procedure, blood loss from procedure (if documented), result of first imaging modality (CXR, CT thorax) at hospital destination. Delayed complications of procedure will be ascertained by a chart review by research staff at each respective hospital. “Empyema” as a complication will be reserved for pleural space infection proven by diagnostic aspiration / drain. “Probable empyema” will be designated to febrile patients started on antibiotics with demonstrable pleural effusion on imaging and no alternative source of fever found. 

Results: 

We hypothesise complications rates to match those currently reported in pre-hospital thoracostomy literature. The study is anticipated to provide a useful measure of current practices and procedures. 

Conclusion: 

The results of this study are anticipated to aid in future policy-making and inform pre-hospital practices within Australia and abroad. 

Time frame: 3 months from start

Supervisor

Dr Peter Del Mar

Academic Title-Senior Lecturer
Royal Brisbane Clinical Unit