{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T16:21:01Z","timestamp":1782750061255,"version":"3.54.5"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T00:00:00Z","timestamp":1669161600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Life\u2010threatening thoracic trauma requires emergency pleural decompression and thoracostomy and chest drain insertion are core trauma procedures. Reliably determining a safe site for pleural decompression in children can be challenging. We assessed whether the Mid\u2010Arm Point (MAP) technique, a procedural aid proposed for use with injured adults, would also identify a safe site for pleural decompression in children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Children (0\u201318\u2009years) attending four EDs were prospectively recruited. The MAP technique was performed, and chest wall skin marked bilaterally at the level of the MAP; no pleural decompression was performed. Radio\u2010opaque markers were placed over the MAP\u2010determined skin marks and corresponding intercostal space (ICS) reported using chest X\u2010ray.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 392 children participated, and 712 markers sited using the MAP technique were analysed. Eighty\u2010three percentage of markers were sited within the \u2018safe zone\u2019 for pleural decompression (4th to 6th ICSs). When sited outside the \u2018safe zone\u2019, MAP\u2010determined markers were typically too caudal. However, if the site for pleural decompression was transposed one ICS cranially in children \u22654\u2009years, the MAP technique performance improved significantly with 91% within the \u2018safe zone\u2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The MAP technique reliably determines a safe site for pleural decompression in children, albeit with an age\u2010based adjustment, the Mid\u2010Arm Point in PAEDiatrics (MAPPAED) rule: \u2018in children aged \u22654\u2009years, use the MAP and go up one ICS to hit the safe zone. In children &lt;4\u2009years, use the MAP.\u2019 When together with this rule, the MAP technique will identify a site within the \u2018safe zone\u2019 in 9 out of 10 children.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1742-6723.14141","type":"journal-article","created":{"date-parts":[[2022,11,24]],"date-time":"2022-11-24T12:34:02Z","timestamp":1669293242000},"page":"412-419","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Mid\u2010Arm Point in PAEDiatrics (MAPPAED): An effective procedural aid for safe pleural decompression in trauma"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7725-7678","authenticated-orcid":false,"given":"Nuala","family":"Quinn","sequence":"first","affiliation":[{"name":"Department of Paediatric Emergency Medicine Children's Health Ireland at Temple Street Dublin Ireland"},{"name":"Emergency Research Group Murdoch Children's Research Institute Melbourne Victoria Australia"},{"name":"National Office for Trauma Services Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grantley","family":"Ward","sequence":"additional","affiliation":[{"name":"Melbourne Medical School The University of Melbourne Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyril","family":"Ong","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging The Royal Children's Hospital Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7173-6993","authenticated-orcid":false,"given":"David","family":"Krieser","sequence":"additional","affiliation":[{"name":"Emergency Research Group Murdoch Children's Research Institute Melbourne Victoria Australia"},{"name":"Melbourne Medical School The University of Melbourne Melbourne Victoria Australia"},{"name":"Department of Emergency Medicine, Sunshine Hospital, Western Health Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6559-3674","authenticated-orcid":false,"given":"Robert","family":"Melvin","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Sandringham Hospital, Alfred Health Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allya","family":"Makhijani","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Sunshine Hospital, Western Health Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Grindlay","sequence":"additional","affiliation":[{"name":"Emergency Research Group Murdoch Children's Research Institute Melbourne Victoria Australia"},{"name":"Department of Emergency Medicine The Royal Children's Hospital Melbourne Victoria Australia"},{"name":"Department of Paediatrics The University of Melbourne Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Lynch","sequence":"additional","affiliation":[{"name":"Department of Paediatric Emergency Medicine Children's Health Ireland at Temple Street Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"Colleran","sequence":"additional","affiliation":[{"name":"Department of Paediatric Radiology Children's Health Ireland at Temple Street Dublin Ireland"},{"name":"Department of Paediatrics, Trinity College Dublin and the National Maternity Hospital Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Perry","sequence":"additional","affiliation":[{"name":"Trauma Service, The Royal Children's Hospital Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sinead M","family":"O'Donnell","sequence":"additional","affiliation":[{"name":"Emergency Research Group Murdoch Children's Research Institute Melbourne Victoria Australia"},{"name":"Department of Emergency Medicine The Royal Children's Hospital Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Law","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Sunshine Hospital, Western Health Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinesh","family":"Varma","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Alfred Health Melbourne Victoria Australia"},{"name":"Department of Surgery Monash University Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"Western Health Medical Imaging, Sunshine Hospital, Western Health Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah J","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Mathematical Sciences Research Centre Queen's University, Belfast UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4747-6025","authenticated-orcid":false,"given":"Warwick J","family":"Teague","sequence":"additional","affiliation":[{"name":"Department of Paediatrics The University of Melbourne Melbourne Victoria Australia"},{"name":"Trauma Service, The Royal Children's Hospital Melbourne Victoria Australia"},{"name":"Department of Paediatric Surgery The Royal Children's Hospital Melbourne Victoria Australia"},{"name":"Surgical Research Group Murdoch Children's Research Institute Melbourne Victoria Australia"},{"name":"School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11,23]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Australian Institute of Health and Welfare.Australia's children (Cat. no. 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