TY - JOUR
T1 - Evaluating emergency department tube thoracostomy
T2 - A single-center use of trauma video review to assess efficiency and technique
AU - Marinica, Alexander L.
AU - Nagaraj, Madhuri B.
AU - Elson, Matthew
AU - Vella, Michael A.
AU - Holena, Daniel N.
AU - Dumas, Ryan P.
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/4
Y1 - 2023/4
N2 - Background: Emergency department tube thoracostomy is a common procedure; however, assessing procedural skills is difficult. We sought to describe procedural variability and technical complications of emergency department tube thoracostomy using trauma video review. We hypothesized that factors such as hemodynamic abnormality lead to increased technical difficulty and malpositioning. Methods: Using trauma video review, we reviewed all emergency department tube thoracostomy from 2020 to 2022. Patients were stratified into hemodynamically abnormal (systolic blood pressure <90 or heart rate >120) and hemodynamically normal (systolic blood pressure ≥90 or heart rate ≤120). Emergency department tube thoracostomies outside of video-capable rooms, with incomplete visualization, or in patients undergoing cardiopulmonary resuscitation or resuscitative thoracotomy were excluded. The primary outcome was a procedure score modified from the validated tool ranging from 0 to 11 (higher score indicating better performance). Also measured were procedural times to (1) decision to place, (2) pleural entry, and (3) procedure completion. Postprocedure x-ray and chart review were used to determine accuracy. Results: In total, 51 videos met the inclusion criteria. The median age was 34 [interquartile range 24–40] years, body mass index 25.8 [interquartile range 21.8–30.7], predominately male (75%), blunt injury (57%), with Injury Severity Score of 22 [14.5–41]. The median procedure score was 9 [7–10]. Emergency department tube thoracostomies in patients with abnormal hemodynamics had significantly lower procedure scores (8 vs 10, P < .05). Hemodynamically abnormal patients had significantly shorter times from decision to proceed to pleural entry (4.05 vs 8.25 minutes, P < .001), and to completion (6.31 vs 14.23 minutes, P < .001). The most common complication was malpositioning (35.1%), with no significant difference noted when comparing hemodynamically normal and abnormal patients (P = .41). Conclusion: Using trauma video review we identified significant procedural variability in emergency department tube thoracostomy, mainly that hemodynamic abnormality led to lower proficiency scores and increased malpositioning. Efforts are needed to define procedural benchmarks and evaluation in the context of patient outcomes. Using this technology and methodology can help establish procedural norms.
AB - Background: Emergency department tube thoracostomy is a common procedure; however, assessing procedural skills is difficult. We sought to describe procedural variability and technical complications of emergency department tube thoracostomy using trauma video review. We hypothesized that factors such as hemodynamic abnormality lead to increased technical difficulty and malpositioning. Methods: Using trauma video review, we reviewed all emergency department tube thoracostomy from 2020 to 2022. Patients were stratified into hemodynamically abnormal (systolic blood pressure <90 or heart rate >120) and hemodynamically normal (systolic blood pressure ≥90 or heart rate ≤120). Emergency department tube thoracostomies outside of video-capable rooms, with incomplete visualization, or in patients undergoing cardiopulmonary resuscitation or resuscitative thoracotomy were excluded. The primary outcome was a procedure score modified from the validated tool ranging from 0 to 11 (higher score indicating better performance). Also measured were procedural times to (1) decision to place, (2) pleural entry, and (3) procedure completion. Postprocedure x-ray and chart review were used to determine accuracy. Results: In total, 51 videos met the inclusion criteria. The median age was 34 [interquartile range 24–40] years, body mass index 25.8 [interquartile range 21.8–30.7], predominately male (75%), blunt injury (57%), with Injury Severity Score of 22 [14.5–41]. The median procedure score was 9 [7–10]. Emergency department tube thoracostomies in patients with abnormal hemodynamics had significantly lower procedure scores (8 vs 10, P < .05). Hemodynamically abnormal patients had significantly shorter times from decision to proceed to pleural entry (4.05 vs 8.25 minutes, P < .001), and to completion (6.31 vs 14.23 minutes, P < .001). The most common complication was malpositioning (35.1%), with no significant difference noted when comparing hemodynamically normal and abnormal patients (P = .41). Conclusion: Using trauma video review we identified significant procedural variability in emergency department tube thoracostomy, mainly that hemodynamic abnormality led to lower proficiency scores and increased malpositioning. Efforts are needed to define procedural benchmarks and evaluation in the context of patient outcomes. Using this technology and methodology can help establish procedural norms.
UR - http://www.scopus.com/inward/record.url?scp=85147411625&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85147411625&partnerID=8YFLogxK
U2 - 10.1016/j.surg.2022.12.028
DO - 10.1016/j.surg.2022.12.028
M3 - Article
C2 - 36740501
AN - SCOPUS:85147411625
SN - 0039-6060
VL - 173
SP - 1086
EP - 1092
JO - Surgery (United States)
JF - Surgery (United States)
IS - 4
ER -