Aims There are no known published studies to support current pitch side guidelines for the management of a tension pneumothorax in a sporting population (1). Temporary management of this condition involves needle thoracocentesis (NT) at the 2nd intercostal space mid clavicular line (2MCL). The 5th intercostal space anterior axillary line (5AAL) has been suggested as an alternative site.1 The aim of the study was to compare chest wall thickness (CWT) at the 2MCL and the 5AAL of an elite rugby union team. The secondary aim was to calculate potential NT failure between player positions; Forwards and Backs.

Methods Potential failure was calculated by comparing CWT in relation to both a standard cannula length of 4.5 cm and the advised needle length of 5.0 cm. Ultrasound recorded three measurements of CWT at the 2MCL and 5AAL on both sides of the thorax.

Results Forty-three male players with a mean age of 25.7 years participated. Forwards demonstrated a thicker CWT than Backs at both sites. The mean CWT at 2MCL was 3.78 cm in Forwards and 3.30 cm in Backs. The mean CWT at the 5AAL site was uniformly thinner and measured 3.16 cm in Forwards and 2.40 cm in Backs. 22.2% (n=6) of Forwards had a CWT greater then 4.5 cm. 11.1% (n=3) of Forwards had a CWT greater then 5.0 cm at 2MCL. For all player positions the CWT at the 5AAL was less than 5.0 cm.

Conclusions Forward position rugby players had a greater CWT than Back players. One in ten Forward players had the potential to fail NT in accordance to suggested guidelines. CWT at the 5AAL was significantly thinner (p<0.05) than at the 2MCL for all players and may be a more suitable NT site for Forward players.