Prehospital needle thoracostomy: What are the indications and is a post-trauma center arrival chest tube required?

OBJECTIVE: This study examined the indications for prehospital needle thoracostomy (pNT), the need for tube thoracostomy (TT) following pNT, and the outcomes of patients who underwent pNT. METHODS: This study is a retrospective chart review of patients who underwent pNT prior to trauma center arrival. Patients were identified from the trauma registry and a quality improvement (QI) database from 9/2014-9/2018. RESULTS: 59 patients underwent 63 pNTs during the time period. The indication for pNT was "hypotension" in only 5 patients (7.9%). A CT chest was obtained on 51 NT attempts with the catheter in place. In 48 (94.1%) NT attempts, the catheter was not in the pleural space. 44 (69.4%) TTs were placed on admission date. CONCLUSION: In patients undergoing pNT, hypotension was rarely the indication. Additionally, CT identified the catheter within the pleural space in only 3 (5.8%) NT attempts. TT placement was performed in 79.3% of NT attempts.

Ventral hernia repair outcomes predicted by a 5-item modified frailty index using NSQIP variables.

PURPOSE: Frailty is a decrease in physiologic reserve that is separate from the normal aging process. Previously, an 11-item modified frailty index (mFI) using NSQIP variables predicted outcomes for surgical patients. We aim to validate a condensed 5-item mFI in ventral hernia patients and determine outcomes and the relative impact of each frailty variable. METHODS: The NSQIP database was queried from 2011 to 2016 for patients undergoing VHR. Spearman's rho correlation was used to determine the degree of correlation between 11-item and 5-item mFI raw frailty scores. Chi squared testing was used to determine odds ratios (95% CI) for accumulating frailty variables in both indices with regard to complications vs a baseline of zero variables present on the 11-item scale. Complications were defined by the Clavien-Dindo (CD) classification. Univariate and multivariate analyses were performed on each frailty variable to determine their relative weighted impacts on outcomes. RESULTS: 97,905 patients (99.45%) had all five frailty variables recorded. Only 11,549 patients (11.73%) had all variables from the 11-item mFI. No difference existed between groups for the five mutually shared frailty variables, BMI, emergent vs non-emergent procedures, operative time, or operative approach. For accumulating variables in both indices, the 5-item mFI predicts incidence of any complications, major complications, and discharge not to home similarly to the 11-item mFI. The most significantly weighted variable for complications and discharge not to home is functional status. CONCLUSION: A 5-item mFI accurately predicts outcomes similar to the validated 11-item mFI and captures more patients for analysis.