128 - Use of a Thoracostomy Landmarking Device Increased Undergraduate Students’ Landmarking Accuracy

Poster Board Number: 128
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Abstract Body : Penetrating chest injuries caused by trauma can lead to a collapsed lung, also called a pneumothorax, due to a buildup of pressure in the lung cavity [1]. In order to relieve this pressure, medical personnel such as paramedics may perform a thoracostomy, which is an insertion of a small needle into the lung cavity. This is a delicate procedure, and error rates range from 5-30% [1].

Paramedic education rarely includes cadaveric training, which research has shown to be beneficial for learning procedures [2]. The aim of this study was to develop cadaveric-based teaching material that demonstrates the anatomical structures relevant to the thoracostomy procedure. As a pilot test of the teaching material, we incorporated it into an HK*3401 laboratory; the goal was to instill students' appreciation of major anatomical structures/relationships in the regions of the thorax and abdomen. Thus, we tested the relative utility of the cadaveric-based teaching material and a commercially available locator device (i.e., SAM ThoraSite®) on participants’ landmarking accuracy. We hypothesized that students given both the ThoraSite® and the cadaveric-based module will be able to landmark for this procedure with higher accuracy.
Cadaveric-based dissections were performed to highlight the anatomy relevant to the thoracostomy procedure. Digital images were acquired and incorporated into an educational module that described basic features of the thoracostomy procedure. Participants (HK*3401 students; n=260) were randomly assigned to 1 of 4 groups. They were shown one of two modules: one incorporated cadaveric-based images, the other did not. They also either did or did not receive the ThoraSite® to help them landmark. Investigators were blind to which module the participants had viewed. Participants were asked to landmark for a thoracostomy on a supine volunteer in under 1 minute. Accuracy was measured by distance in cm away from the correct location.
A foundational goal of this project was to develop cadaveric-based teaching material that demonstrates the anatomical structures and relationships relevant to the thoracostomy procedure (Figure 1). Thoracostomy landmarking was more accurate for participants utilizing the ThoraSite® versus those who did not (p< 0.01). Thoracostomy landmarking did not differ between participants utilizing the cadaveric-based module versus the general module (p< 0.8).
Data suggests that the ThoraSite® is a useful tool that enables appropriate landmarking required during the clinical procedure of thoracostomy. Contrary to the hypothesis, the cadaveric-based module showed no benefit for placement accuracy relative to the general module. Possible explanations for these findings could be the length of modules (less than two minutes each) and/or the limited knowledge of the region prior to the study. Additionally, research conditions may not be reminiscent of the high-stress environment paramedics face when the thoracostomy is required. Strengths of the study include random assignment of scenarios and blinding of investigators to control and treatment variables.
The ThoraSite® may be a useful tool for first responders to reduce landmarking errors when performing the thoracostomy. Future research should investigate a similar intervention with first responders.