Determining factors associated with chest wall thickness for emergency needle decompression in Thai population

Abstract Objectives Needle decompression is a lifesaving procedure; however, the success rate may be limited. Chest wall thickness (CWT) is an important factor related to the success rate. This study aimed to identify the optimal anatomical site for needle decompression by comparing CWT and predicted risk of vital organ injury across three locations. A secondary objective was to explore significant predictors of CWT for clinical application. Material and Methods This retrospective cohort study involved patients aged ≥20 years who underwent a chest computed tomography scan for trauma and nontrauma indications between May 2017 and October 2022. CWT was measured at three anatomical sites, and differences in thickness and risk of organ injury were compared across these locations. Results The CWT was most strongly correlated with chest wall diameter (CWD), body mass index (BMI), and sex. The thinnest location was at the fifth intercostal space (ICS) anterior axillary line (AAL) (right: 2.21 [1.52, 3.04] cm and left: 2.14 [1.43, 2.97] cm) then at the second ICS midclavicular line (MCL) (right: 2.97 [2.24, 3.69] cm and left: 2.95 [2.28, 3.68] cm) and fifth ICS midaxillary line (MAL) (right: 3.74 [2.44, 5.04] cm and eft: 3.88 [2.5, 5.07] cm) with all pairwise comparisons showing significant differences ( p < 0.05). The diaphragm was the shallowest vital organ (right: 4.42 [3.32, 5.34] cm and left: 4.20 [3.61, 5.50] cm); however, the pericardium was identified as the most at‐risk vital organ for injury (approximately 42%), which was most observed at the left fifth ICS‐AAL. Conclusion This study suggests that the second ICS‐MCL may be a safer and more practical site for needle decompression in the Thai population, particularly on the left side. In addition, BMI, sex, and CWD were identified as significant predictors of CWT, which may help guide clinical decision‐making.