Prehospital needle decompression associated with decreased mortality in trauma patients

1. Prehospital needle decompression (PHND) was associated with decreased odds of 24-hour mortality in trauma patients, compared to patients receiving an emergent tube thoracotomy.

Evidence Rating Level: 2 (Good)

Chest trauma is a contributory factor to trauma mortality in 60% of cases.  The practice of prehospital needle compression (PHND) is aimed at treating tension pneumothorax in patients prior to hospital arrival, but its effectiveness at preventing mortality is unclear, with only smaller scale studies available, often lacking a comparator group. Therefore, this cohort study aimed to examine the association between PHND and risk of 24-hour mortality in trauma cases, with the comparator group being patients who received an emergent tube thoracostomy within 15 minutes of hospital arrival. The study population consisted of 8469 trauma patients from 44 trauma centres between 2000 and 2020. The results showed that the rate of PHND was stable throughout the study period, between 0.2 and 0.5%. 15.8% of patients included in the study underwent PHND and 84.2% underwent emergent tube thoracostomy, with patient factors and emergency medical service (EMS) agency accounting for 12% and 88% of the variation in PHND rates respectively. There was a significant decrease in 24-hour mortality associated with PHND (odds ratio 0.75, 95% CI 0.61-0.94, p = 0.01). The lower odds remained significant amongst patients with severe chest injury (OR 0.72, 95% CI 0.55-0.93, p = 0.01) and patients without a severe traumatic brain injury (OR 0.65, 95% CI 0.45-0.95, p = 0.03). This was also significant when 92% of PHND patients were propensity-matched to emergent tube thoracostomy patients, with a 21% lower odds of 24-hour mortality (OR 0.9, 95% CI 0.62-0.98, p = 0.04). Overall, this study showed that the practice of PHND is associated with a reduction in 24-hour mortality, compared to trauma patients just receiving an emergent tube thoracostomy.

Click to read the study in JAMA Surgery

Image: PD

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