{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T13:44:19Z","timestamp":1761745459039,"version":"build-2065373602"},"reference-count":20,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T00:00:00Z","timestamp":1761350400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002631","name":"Gachon University","doi-asserted-by":"publisher","award":["GCU-202310460001","GCU-202410290001"],"award-info":[{"award-number":["GCU-202310460001","GCU-202410290001"]}],"id":[{"id":"10.13039\/501100002631","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Accurate and prompt tube thoracostomy (TT) placement within the safety zone while avoiding diaphragmatic injury remains challenging, particularly in trauma patients with distorted thoracic anatomy. This study evaluated the accuracy and safety of landmark-based TT techniques, including a novel mid-sternum method. Methods: In this retrospective study, chest computed tomography scans of 245 adult trauma patients who presented to a Level I trauma center in Korea between February and June 2022 were analyzed. TT insertion routes using the mid-sternum, nipple, and mid-arm point methods were compared against the conventional fifth intercostal space (ICS) method. Results: Of the 245 enrolled patients, the median age was 55.0 years (interquartile range, 42.0\u201364.0), and 186 (75.9%) were male. On the right side, routes avoiding the diaphragm were observed in 82.0% (fifth ICS), 92.7% (mid-sternum), 55.5% (nipple), and 90.2% (mid-arm point) of patients. The mid-sternum method showed a significantly higher avoidance rate than the fifth ICS method (p &lt; 0.001), with 91.1% sensitivity and 77.4% specificity for identifying TT routes within the safety zone. On the left side, routes avoiding the diaphragm were observed in 97.6% (fifth ICS), 98.8% (mid-sternum), 86.9% (nipple), and 95.1% (mid-arm point) of patients, with no significant difference between the fifth ICS and mid-sternum methods (p = 0.375). The mid-sternum method showed 90.4% sensitivity and 85.2% specificity for routes within the safety zone. Conclusions: The mid-sternum method demonstrated high anatomical safety and performance comparable to or superior to the conventional fifth ICS method, particularly in minimizing the risk of diaphragmatic injury. It may offer a practical and safe alternative for TT placement in trauma care.<\/jats:p>","DOI":"10.3390\/jcm14217571","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T09:16:24Z","timestamp":1761729384000},"page":"7571","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Determination of the Optimal Landmark for Tube Thoracostomy in Trauma Patients: A Retrospective Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5892-9428","authenticated-orcid":false,"given":"Mina","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3202-749X","authenticated-orcid":false,"given":"Jaeik","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Traumatology, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9710-3265","authenticated-orcid":false,"given":"Jae-Hyug","family":"Woo","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea"},{"name":"Gachon University College of Medicine, Incheon 21565, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8324-9749","authenticated-orcid":false,"given":"Hyuk Jun","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea"},{"name":"Gachon University College of Medicine, Incheon 21565, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0011-0985","authenticated-orcid":false,"given":"Woo Sung","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea"},{"name":"Gachon University College of Medicine, Incheon 21565, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8625-9803","authenticated-orcid":false,"given":"Jae Ho","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea"},{"name":"Gachon University College of Medicine, Incheon 21565, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9419-244X","authenticated-orcid":false,"given":"Sung Youl","family":"Hyun","sequence":"additional","affiliation":[{"name":"Department of Traumatology, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea"},{"name":"Gachon University College of Medicine, Incheon 21565, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1097\/PEC.0000000000003207","article-title":"Ultrasound Investigation of the Fifth Intercostal Space Landmark for Chest Tube Thoracostomy Site Selection in Pediatric Patients","volume":"40","author":"Ruthford","year":"2024","journal-title":"Pediatr. 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Sci."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7571\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T09:50:04Z","timestamp":1761731404000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7571"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,25]]},"references-count":20,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14217571"],"URL":"https:\/\/doi.org\/10.3390\/jcm14217571","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,25]]}}}