Effects of age, sex and body anthropometry on needle thoracostomy in a Singapore paediatric cohort: a chest CT study.

INTRODUCTION

Tension pneumothorax in children, although infrequently encountered, requires management with a high level of confidence and skill from the attending physician. Despite this, recommendations on location and needle length for needle thoracostomy (NT) in paediatric patients are not well-established. We therefore aimed to (1) identify how age, sex and body anthropometry affect chest wall thickness (CWT) at common NT landmarks and (2) determine the adequacy of needle lengths used.

METHODS

A retrospective review was undertaken of chest CT scans performed on children aged 0-17 years at KK Women's and Children's Hospital in Singapore. Patients were categorised as infants (<1 year old), children (1-9 years old) and adolescents (10-17 years old). Bilateral CWT at the second intercostal space (ICS) mid-clavicular line (MCL) and fourth ICS mid-axillary line (MAL) were measured radiographically. Adequacy of needle length is defined as CWT < needle length in >95% of cases.

RESULTS

588 CT scans (192 infants, 224 children, 172 adolescents) were reviewed. Mean CWT at the second ICS MCL was 12.61 mm (SD±4.14 mm), 15.62 mm (SD±4.88 mm) and 26.64 mm (SD±11.48 mm) for infants, children and adolescents, respectively. Mean CWT at the fourth ICS MAL is 14.95 mm (SD±5.25 mm), 16.49 mm (SD±5.89 mm) and 28.20 mm (SD±11.53 mm) for infants, children and adolescents, respectively. Adequate needle length was 25 mm, 32 mm and 50 mm for infants, children and adolescents, respectively, when inserted at the second ICS MCL.

CONCLUSION

In a Singaporean population, mean CWT at the second ICS MCL is thinner than mean CWT at the fourth ICS MAL for all age, sex, weight-for-length and body mass index categories. For successful NT at the second ICS MCL, a 25 mm needle is recommended for infants, 32 mm for children and 50 mm for adolescents.