Tibial Intraosseous Insertion in Pediatric Emergency Care: A Review Based upon Postmortem Computed Tomography

Area of Science:

• Emergency Medicine
• Pediatric Critical Care
• Forensic Radiology

Background:

• The proximal tibia is a standard site for pediatric emergency intraosseous (IO) vascular access.
• Accuracy of emergency tibial IO access placement in children has not been thoroughly evaluated using postmortem imaging.

Purpose of the Study:

• To evaluate the accuracy of emergency tibial intraosseous (IO) vascular access placement in pediatric cases using postmortem computed tomography (PMCT).

Main Methods:

• Retrospective review of 92 medical examiner cases involving tibial IO devices.
• Classification of IO insertions as successful (needle tip in medullary canal) or unsuccessful (non-medullary placement).
• Analysis of patient age, equipment used, and care setting (prehospital vs. hospital).

Main Results:

• 42 tibial IO devices were identified in 31 cases (infants to 16 years).
• Overall successful placement was 60% (25/42); 40% (17/42) were unsuccessful (tibia perforation, cortex embedding, missed bone).
• In infants ≤6 months, 15-mm needles had a 56% success rate, while 25-mm needles had a 0% success rate (5/5 unsuccessful).

Conclusions:

• Tibial intraosseous (IO) needle insertion in infants ≤6 months has a significant failure rate (53%).
• Failures occur in both prehospital and emergency department settings.
• Avoid 25-mm needles in infants ≤6 months; review and modify IO insertion procedures for this age group.