Finger thoracostomy: Significant risks and unproven benefits in prehospital settings.

IF 2.5 3区 医学 Q2 HEMATOLOGY
Transfusion Pub Date : 2025-03-25 DOI:10.1111/trf.18198
Yael Mozer-Glassberg, Irina Radomislensky, Avi Benov, Ofer Almog
{"title":"Finger thoracostomy: Significant risks and unproven benefits in prehospital settings.","authors":"Yael Mozer-Glassberg, Irina Radomislensky, Avi Benov, Ofer Almog","doi":"10.1111/trf.18198","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Trauma is a leading cause of preventable death, with a significant portion of trauma deaths occurring in the prehospital setting. Interventions such as chest drainage may play a critical role in managing life-threatening conditions but face challenges due to poorly defined indications and reliance on anecdotal evidence rather than rigorous studies. Among chest drainage techniques, finger thoracostomy (FT) is a well-described, but controversial, method for decompressing the pleural cavity in emergencies like tension pneumothorax or hemothorax. Despite its simplicity and minimal equipment requirements, FT carries risks, including bleeding, infection, organ injury, temporary effects, and procedural failure.</p><p><strong>Study design and methods: </strong>This study examines eight FT procedures performed by Israel Defense Forces providers during the 2023-2024 \"Swords of Iron\" War in Gaza.</p><p><strong>Results: </strong>All patients sustained severe penetrating injuries, with mixed outcomes. One case highlighted severe complications, including infection and empyema weeks later. Additionally, challenges in maintaining up-to-date knowledge and adherence to protocols among reservists led to unauthorized FT procedures, emphasizing the dangers of improvisation without evidence.</p><p><strong>Discussion: </strong>Our findings, coupled with limited evidence for FT's effectiveness in prehospital settings, raise questions about its appropriateness in trauma care. These concerns highlight the critical importance of adhering to validated and evidence-based protocols in all aspects of medical practice. Deviating from such protocols not only introduces unnecessary risks but also undermines the standardization essential for optimal patient care. Further research is needed to clarify the role, if any, of FT in prehospital trauma management.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transfusion","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/trf.18198","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEMATOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Trauma is a leading cause of preventable death, with a significant portion of trauma deaths occurring in the prehospital setting. Interventions such as chest drainage may play a critical role in managing life-threatening conditions but face challenges due to poorly defined indications and reliance on anecdotal evidence rather than rigorous studies. Among chest drainage techniques, finger thoracostomy (FT) is a well-described, but controversial, method for decompressing the pleural cavity in emergencies like tension pneumothorax or hemothorax. Despite its simplicity and minimal equipment requirements, FT carries risks, including bleeding, infection, organ injury, temporary effects, and procedural failure.

Study design and methods: This study examines eight FT procedures performed by Israel Defense Forces providers during the 2023-2024 "Swords of Iron" War in Gaza.

Results: All patients sustained severe penetrating injuries, with mixed outcomes. One case highlighted severe complications, including infection and empyema weeks later. Additionally, challenges in maintaining up-to-date knowledge and adherence to protocols among reservists led to unauthorized FT procedures, emphasizing the dangers of improvisation without evidence.

Discussion: Our findings, coupled with limited evidence for FT's effectiveness in prehospital settings, raise questions about its appropriateness in trauma care. These concerns highlight the critical importance of adhering to validated and evidence-based protocols in all aspects of medical practice. Deviating from such protocols not only introduces unnecessary risks but also undermines the standardization essential for optimal patient care. Further research is needed to clarify the role, if any, of FT in prehospital trauma management.

手指开胸术:院前设置的重大风险和未经证实的益处。
背景:创伤是可预防死亡的主要原因,很大一部分创伤死亡发生在院前环境。胸腔引流等干预措施可能在管理危及生命的疾病中发挥关键作用,但由于适应症定义不清以及依赖轶事证据而不是严格的研究,因此面临挑战。在胸腔引流技术中,手指开胸术(FT)是一种描述良好但存在争议的方法,用于在紧急情况下减压胸膜腔,如紧张性气胸或血胸。尽管手术简单且设备要求最低,但FT仍存在出血、感染、器官损伤、暂时性影响和手术失败等风险。研究设计和方法:本研究考察了2023-2024年加沙“铁剑”战争期间以色列国防军供应商执行的8个FT程序。结果:所有患者均为严重穿透性损伤,预后不一。一个病例在几周后出现了严重的并发症,包括感染和脓胸。此外,在保持最新知识和遵守预备役人员协议方面的挑战导致未经授权的FT程序,强调了在没有证据的情况下即兴发挥的危险。讨论:我们的研究结果,加上FT在院前环境中有效性的有限证据,对其在创伤护理中的适用性提出了质疑。这些关切突出了在医疗实践的各个方面遵守经过验证的循证协议的至关重要性。偏离这些协议不仅会带来不必要的风险,还会破坏最佳患者护理所必需的标准化。需要进一步的研究来阐明FT在院前创伤管理中的作用,如果有的话。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Transfusion
Transfusion 医学-血液学
CiteScore
4.70
自引率
20.70%
发文量
426
审稿时长
1 months
期刊介绍: TRANSFUSION is the foremost publication in the world for new information regarding transfusion medicine. Written by and for members of AABB and other health-care workers, TRANSFUSION reports on the latest technical advances, discusses opposing viewpoints regarding controversial issues, and presents key conference proceedings. In addition to blood banking and transfusion medicine topics, TRANSFUSION presents submissions concerning patient blood management, tissue transplantation and hematopoietic, cellular, and gene therapies.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信