The role of point of care ultrasound in prehospital critical care: a systematic review

Bøtker, Morten Thingemann; Jacobsen, Lars; Rudolph, Søren Steemann; Knudsen, Lars

doi:10.1186/s13049-018-0518-x

Cited by 92 publications

(70 citation statements)

References 42 publications

(96 reference statements)

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“…Secondarily the study demonstrated that triage level higher than 1 is a significant predictor of POCUS being potentially beneficial. It has been suggested that POCUS should be symptom based and focused [35]. Despite the fact that the design of the present study cannot prove causal relationship the results suggest that screening with whole-body ultrasound might be indicated if triage level is high.…”

Section: Discussioncontrasting

confidence: 62%

Point-of-care ultrasound induced changes in management of unselected patients in the emergency department - a prospective single-blinded observational trial

Weile

Frederiksen

Laursen

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Point-of-Care ultrasound (POCUS) changes the management in specific groups of patients in the Emergency Department (ED). It seems intuitive that POCUS holds an unexploited potential on a wide variety of patients. However, little is known about the effect of ultrasound on the broad spectrum of unselected patients in the ED. This study aimed to identify the effect on the clinical management if POCUS was applied on unselected patients. Secondarily the study aimed to identify predictors of ultrasound changing management. Methods: This study was a blinded observational single center trial. A basic whole body POCUS protocol was performed in extension to the physical examination. The blinded treating physicians were interviewed about the presumptive diagnosis and plan for the patient. Subsequently the physicians were unblinded to the POCUS results and asked to choose between five options regarding the benefit from POCUS results. Results: A total of 403 patients were enrolled in this study. The treating physicians regarded POCUS examinations influence on the diagnostic workup or treatment as following: 1) No new information: 249 (61.8%), 2) No further action: 45 (11.2%), 3) Further diagnostic workup needed: 52 (12.9%), 4) Presumptive diagnosis confirmed 38 (9.4%), and 5) Immediate treatment needed: 19 (4.7%). Predictors of beneficial ultrasound were: (a) triage > 1, (b) patient comorbidities (cardiac disease, hypertension or lung disease), or (c) patients presenting with abdominal pain, dyspnea, or syncope. Conclusion: POCUS was found to be potentially beneficial in 27.0% of all patients. High triage score, known cardiac disease, hypertension, pulmonary diseases, a clinical presentation with abdominal pain, dyspnea, or syncope are predictors of this. Future research should focus on patient-important outcomes when applying POCUS on these patients.

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Section: Discussioncontrasting

confidence: 62%

Point-of-care ultrasound induced changes in management of unselected patients in the emergency department - a prospective single-blinded observational trial

Weile

Frederiksen

Laursen

et al. 2020

Scand J Trauma Resusc Emerg Med

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“…To our knowledge, this is the first study to evaluate the feasibility of focused prehospital TTE obtained by paramedics in suspected NSTE-ACS (18). This study confirmed that paramedics could acquire and transfer interpretable TTE images in most patients with NSTE-ACS.…”

Section: Discussionsupporting

confidence: 70%

Prehospital risk stratification in non-ST-elevation acute coronary syndrome; a paramedic echocardiography pilot study.

Jacobsen

Jortveit²,

Moe

et al. 2020

Preprint

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Background Prehospital risk stratification and timing of revascularization in Acute Coronary Syndromes (ACS) is currently based on the electrocardiogram (ECG). ST- elevation in the ECG indicates myocardial infarction (STEMI) in need of immediate reperfusion therapy. However, a large group of ACS patients presents without ST-elevation in ECG, despite coronary occlusions. In these high risk non-ST-elevation myocardial infarctions (NSTEMI), immediate reperfusion may be just as crucial for the prognosis, but prehospital diagnostic tools to identify them are lacking. Objective This pilot study investigated if focused prehospital transthoracic echocardiography (TTE) images achieved by paramedics could be transferred to the in-hospital cardiologist for diagnostic evaluation, and test if this, in combination with a point-of-care (POC) high-sensitive Troponin-T (Hs-cTnT) test, facilitates prehospital identification of high risk NSTE-ACS. Methods Paramedics were trained to obtain focused prehospital TTE images and provide POC Hs-cTnT - testing in patients with suspected ACS. The information was transferred to the in-hospital cardiologist who determined the treatment strategy by evaluating the information provided by the paramedics. Results 123 patients were included between November 30 th 2017 and November 30 th 2018. TTE images were interpretable in 107 cases (87%), and Hs-cTnT measures in 113 cases (93%). NSTEMI was the final diagnosis in 16 patients (13%), where 13 got admitted directly for percutaneous coronary intervention (PCI). These patients bypassed the local hospital and saved time to treatment based on the prehospital detection of NSTE-ACS. Conclusion Interpretable focused TTE images and POC Hs-cTnT measures can be achieved by paramedics in most patients with suspected NSTE-ACS. This information seems to aid in-hospital cardiologist admitting the right patients to the PCI hospital. The study strongly indicates that prehospital diagnostics and risk assessment of patients with suspected NSTE-ACS is feasible. A larger study is needed to clarify the diagnostic accuracy of focused prehospital TTE in suspected NSTE-ACSTrial registration Clinical trials NCT04223986, ID: 17/05178-2 – 522). Registered retrospectively September 23rd 2018. https://clinicaltrials.gov/show/NCT04223986.

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“…Although it was initially considered as marginal, ultrasound has become an indispensable diagnostic tool for the emergency physician of today and most likely for the general practitioner of tomorrow. There are abundant scientific publications regarding its use in civilian emergency medicine9–13 and military medicine14–18 over the past 10 years; therefore, some colleges of emergency medicine have published official recommendations19 20 to define indications and levels of competence required for its use. In fact, the training of non-specialist physicians was quite disparate until recently.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of point-of-care ultrasound in military medical emergencies performed by young military medicine residents

Perrier¹,

Leyral

Thabouillot

et al. 2019

BMJ Mil Health

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IntroductionTo evaluate the usefulness of point-of-care ultrasound (POCUS) performed by young military medicine residents after short training in the diagnosis of medical emergencies.MethodsA prospective study was performed in the emergency department of a French army teaching hospital. Two young military medicine residents received ultrasound training focused on gall bladder, kidneys and lower limb veins. After clinical examination, they assigned a ‘clinicaldiagnostic probability’ (CP) on a visual analogue scale from 0 (definitely not diagnosis) to 10 (definitive diagnosis). The same student performed ultrasound examination and assigned an ‘ultrasounddiagnostic probability’ (UP) in the same way. The absolute difference between CP and UP was calculated. This result corresponded to the Ultrasound Diagnostic Index (UDI), which was positive if UP was closer to the final diagnosis than CP (POCUS improved the diagnostic accuracy), and negative conversely (POCUS decreased the diagnostic accuracy).ResultsForty-eight patients were included and 48 ultrasound examinations were performed. The present pathologies were found in 14 patients (29%). The mean UDI value was +3 (0–5). UDI was positive in 35 exams (73%), zero in 12 exams (25%) and negative in only one exam (2%).ConclusionPOCUS performed after clinical examination increases the diagnostic accuracy of young military medicine residents.

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The role of point of care ultrasound in prehospital critical care: a systematic review

Cited by 92 publications

References 42 publications

Point-of-care ultrasound induced changes in management of unselected patients in the emergency department - a prospective single-blinded observational trial

Point-of-care ultrasound induced changes in management of unselected patients in the emergency department - a prospective single-blinded observational trial

Prehospital risk stratification in non-ST-elevation acute coronary syndrome; a paramedic echocardiography pilot study.

Usefulness of point-of-care ultrasound in military medical emergencies performed by young military medicine residents

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