A Comparison of Tube Thoracostomy for Chest Trauma Between Prehospital and Inhospital Settings

Published:November 17, 2022DOI:



      We compared the outcomes of patients with tube thoracostomy for chest trauma between the prehospital and inhospital settings.


      The subjects were then divided into 2 groups: the prehospital group, which included subjects who underwent tube thoracostomy in the prehospital setting, and the inhospital group, which included subjects who underwent tube thoracostomy in the inhospital setting. The variables were compared between the 2 groups.


      There were no significant differences between the 2 groups with regard to gender, age, history, mechanism of injury, infusion of antibiotics, white blood cell count, duration of insertion of a chest drain, mechanical ventilation, complication of drain infection, duration of admission, or final outcome. However, the Injury Severity Score, maximum C-reactive protein level, and maximum temperature during hospitalization in the prehospital group (n = 15) were significantly greater than those in the inhospital group (n = 119).


      The present study suggested that thoracostomy performed by physicians in the prehospital setting was safe and did not have an increased risk of infection. In addition, thoracostomy for chest injury in the prehospital setting suggested an improvement in the likelihood of a survival outcome.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Air Medical Journal
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hogg JR
        • Caccavale M
        • Gillen B
        • et al.
        Tube thoracostomy: a review for the interventional radiologist.
        Semin Intervent Radiol. 2011; 28: 39-47
        • Meizoso JP
        • Valle EJ
        • Allen CJ
        • et al.
        Decreased mortality after prehospital interventions in severely injured trauma patients.
        J Trauma Acute Care Surg. 2015; 79: 227-231
        • Spanjersberg WR
        • Ringburg AN
        • Bergs EA
        • Krijen P
        • Schipper IB.
        Prehospital chest tube thoracostomy: effective treatment or additional trauma?.
        J Trauma. 2005; 59: 96-101
        • Ota S
        • Jitsuiki K
        • Muramatsu KI
        • et al.
        Analysis of the dispatch of physician staffed-helicopters in the COVID-19 pandemic.
        Am J Emerg Med. 2022; 54: 306-308
        • Ohsaka H
        • Ishikawa K
        • Omori K
        • Jitsuiki K
        • Yoshizawa T
        • Yanagawa Y.
        Management of mass casualties using doctor helicopters and doctor cars.
        Air Med J. 2017; 36: 203-207
        • Mohrsen S
        • McMahon N
        • Corfield A
        • McKee S.
        Complications associated with pre-hospital open thoracostomies: a rapid review.
        Scand J Trauma Resusc Emerg Med. 2021; 29: 166
        • High K
        • Brywczynski J
        • Guillamondegui O.
        Safety and efficacy of thoracostomy in the air medical environment.
        Air Med J. 2016; 35: 227-230
        • Kaserer A
        • Stein P
        • Simmen HP
        • Spahn DR
        • Neuhaus V.
        Failure rate of prehospital chest decompression after severe thoracic trauma.
        Am J Emerg Med. 2017; 35: 469-474
        • Peters J
        • Ketelaars R
        • van Wageningen B
        • Biert J
        • Hoogerwerf N.
        Prehospital thoracostomy in patients with traumatic circulatory arrest: results from a physician-staffed helicopter emergency medical service.
        Eur J Emerg Med. 2017; 24: 96-100
        • Massarutti D
        • Trillò G
        • Berlot G
        • et al.
        Simple thoracostomy in prehospital trauma management is safe and effective: a 2-year experience by helicopter emergency medical crews.
        Eur J Emerg Med. 2006; 13: 276-280
        • Schmidt U
        • Stalp M
        • Gerich T
        • Blauth M
        • Maull KI
        • Tscherne H.
        Chest tube decompression of blunt chest injuries by physicians in the field: effectiveness and complications.
        J Trauma. 1998; 44: 98-101
        • York D
        • Dudek L
        • Larson R
        • Marshall W
        • Dries D.
        A comparison study of chest tube thoracostomy: air medical crew and in-hospital trauma service.
        Air Med J. 1993; 12: 227-229
        • Aylwin CJ
        • Brohi K
        • Davies GD
        • Walsh MS.
        Pre-hospital and in-hospital thoracostomy: indications and complications.
        Ann R Coll Surg Engl. 2008; 90: 54-57
        • Kushida Y
        • Jitsuiki K
        • Muramatsu KI
        • et al.
        A comparison of physician-staffed helicopters and ground ambulances transport for the outcome of severe thoracic trauma patients.
        Am J Emerg Med. 2021; 45: 358-360
        • Yanagawa Y
        • Omori K
        • Muramatsu KI
        • et al.
        Prognostic factors in trauma patients transported by physician-staffed helicopter in Japan: an investigation based on the Japan Trauma Data Bank.
        Air Med J. 2020; 39: 494-497
        • Lesperance RN
        • Carroll CM
        • Aden JK
        • Young JB
        • Nunez TC.
        Failure rate of prehospital needle decompression for tension pneumothorax in trauma patients.
        Am Surg. 2018; 84: 1750-1755
        • Weichenthal L
        • Crane D
        • Rond L.
        Needle thoracotomy in the prehospital setting: a retrospective observational study.
        Prehosp Emerg Care. 2016; 20: 399-403