Harrell Kevin N, Brooks Dylan E, Palm Preston H, Cowart Jonathan T, Maxwell Robert, Barker Donald
4285 Department of Surgery, College of Medicine, University of Tennessee, Chattanooga, TN, USA.
Life Force Air Medical Services, Erlanger Health System, Chattanooga, TN, USA.
Am Surg. 2020 Jul;86(7):841-847. doi: 10.1177/0003134820940238. Epub 2020 Jul 28.
Prehospital chest decompression can be a lifesaving procedure in severe chest trauma. Studies investigating prehospital chest decompression are mostly European where physicians are assigned to prehospital care units. This report is one of the first to compare demographics and outcomes in patients undergoing prehospital chest decompression by trained aeromedical nonphysician personnel to hospital chest decompression by physicians.
Prehospital tube thoracostomy (PTT) patients were identified from January 2014 to January 2019 and were matched in a 1:2 ratio based on age, Injury Severity Score (ISS), and chest Abbreviated Injury Score (AIS) to patients who underwent hospital tube thoracostomy (HTT) within 24 hours of admission.
Forty-nine PTT patients were matched to 98 HTT patients. PTT patients had lower admission Glasgow Coma Scale (GCS), a higher rate of pre-chest tube needle decompression, and higher level 1 trauma activation. PTT were placed sooner (21.9 vs 157.0 minutes, < .001). Rates of tube malposition, organ injury, tube dislodgement, empyema, and hospital-acquired pneumonia over the course of hospital admission were not significantly different between the 2 groups. PTT patients had longer intensive care unit length of stay (LOS), but similar hospital LOS, and overall mortality.
This report demonstrates that PTT is performed sooner than hospital placed tubes. Complication rates associated with tube thoracostomy and patient outcomes were not statistically different between PTT and HTT groups.
院前胸部减压对于严重胸部创伤可能是一种挽救生命的操作。调查院前胸部减压的研究大多来自欧洲，那里医生被分配到院前护理单位。本报告是首批比较由训练有素的航空医疗非医生人员进行院前胸部减压的患者与由医生进行院内胸部减压的患者的人口统计学和结局的报告之一。
从2014年1月至2019年1月确定院前胸腔闭式引流术（PTT）患者，并根据年龄、损伤严重度评分（ISS）和胸部简明损伤评分（AIS）以1:2的比例与入院后24小时内接受院内胸腔闭式引流术（HTT）的患者进行匹配。
49例PTT患者与98例HTT患者相匹配。PTT患者入院时格拉斯哥昏迷量表（GCS）评分较低，胸部置管前针减压率较高，1级创伤激活水平较高。PTT置管时间更早（21.9分钟对157.0分钟，P <.001）。两组在住院期间的导管位置异常、器官损伤、导管移位、脓胸和医院获得性肺炎发生率无显著差异。PTT患者的重症监护病房住院时间（LOS）较长，但住院LOS相似，总体死亡率也相似。
本报告表明PTT比院内置管更早进行。PTT组和HTT组与胸腔闭式引流术相关的并发症发生率和患者结局在统计学上无差异。
