Knobloch Rebecca, Metelmann Camilla, Metelmann Bibiana, Rübsam Marie-Luise, Krämer Bernd, Krämer Sebastian, Metelmann Isabella B
Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Bereich Thoraxchirurgie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland.
Klinik für Anästhesie, Intensiv-, Notfall- und Schmerzmedizin, Universitätsmedizin Greifswald KöR, Greifswald, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2024 May;186:27-34. doi: 10.1016/j.zefq.2024.03.009. Epub 2024 Apr 24.
The prehospital placement of chest tubes is a rare but potentially life-saving procedure. A high level of subjective confidence with the procedure is essential for emergency medical doctors. This study aims to identify if there is a statistically significant difference in the subjective sense of confidence in prehospital chest tube placement regarding medical experience and qualification, clinical routine, and attendance at simulation courses.
Prehospital emergency physicians of three emergency medical services in Southwest Saxony, Greifswald, and Vechta, Germany, were invited to participate in an online survey from January to March 2022 using the online survey service limesurvey. The question "Do you feel confident in chest tube placement?" was used to measure the subjective level of confidence. Answers were compared with data concerning medical qualification, experience in prehospital emergency medicine, clinical routine, and attendance at simulation courses. Statistical analysis was performed using chi-squared test and Fisher's exact test.
Three out of four participants felt confident in chest tube placement (53/71; 74.6%). More than half of the participants reported that they did not perform this procedure regularly (35/53, 66%). Subjective confidence was highest in physicians who regularly place chest tubes during their non-prehospital work (34/37; 91,9%; p<0.001), and more often when participants had clinical routine and attended simulation courses than when none of this applied (p=0.012). Attendance at simulation courses alone was not associated with a higher level of confidence (p=0.002). Specialists showed significantly more often subjective confidence in chest tube placement (p=0.0401).
Prehospital chest tube placement is rare, but potentially lifesaving. An adequately high level of subjective confidence in the placement of chest tubes is a key condition for prehospital emergency doctors. Inhospital clinical routine and attendance at simulation courses are significantly associated with high levels of confidence. Our data indicate that working only in prehospital emergency settings without further clinical routine or medical specialization is not sufficient for achieving and ensuring subjective confidence in chest tube placement.
院前放置胸管是一种罕见但可能挽救生命的操作。急诊医生对该操作有高度的主观信心至关重要。本研究旨在确定在院前胸管放置的主观信心方面，医学经验和资质、临床常规以及参加模拟课程是否存在统计学上的显著差异。
邀请德国萨克森州西南部、格赖夫斯瓦尔德和韦希塔三个急救服务机构的院前急诊医生于2022年1月至3月使用在线调查服务limesurvey参与在线调查。“你对放置胸管有信心吗？”这个问题用于衡量主观信心水平。将答案与有关医学资质、院前急诊医学经验、临床常规以及参加模拟课程的数据进行比较。使用卡方检验和费舍尔精确检验进行统计分析。
四分之三的参与者对放置胸管有信心（53/71；74.6%）。超过一半的参与者报告称他们不经常进行此操作（35/53，66%）。在非院前工作期间经常放置胸管的医生主观信心最高（34/37；91.9%；p<0.001），并且当参与者有临床常规且参加模拟课程时比没有这些情况时更常出现主观信心（p=0.012）。仅参加模拟课程与更高的信心水平无关（p=0.002）。专科医生对放置胸管表现出主观信心的情况明显更常见（p=0.0401）。
院前放置胸管很少见，但可能挽救生命。对胸管放置有足够高的主观信心是院前急诊医生的关键条件。院内临床常规和参加模拟课程与高信心水平显著相关。我们的数据表明，仅在院前急诊环境中工作而没有进一步的临床常规或医学专科化不足以实现并确保对胸管放置的主观信心。
