Prehospital ultrasound in the management of trauma patients: Systematic review of the literature. Issue 12 (December 2019)

• Record Type: Journal Article
• Authors: van der Weide, Laura; Popal, Zar; Terra, Maartje; Schwarte, Lothar A.; Ket, Johannes C.F.; Kooij, Fabian O.; Exadaktylos, Aristomenis K.; Zuidema, Wietse P.; Giannakopoulos, Georgios F.
• Is Part Of: Injury. Volume 50:Issue 12(2019)
• Page Start: 2167
• Page End: 2175
• Publication Date: 2019-12
• Subjects: Prehospital -- Ultrasound -- Focused assessment with sonography in trauma (FAST) -- Trauma patients; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2019.09.034
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: In 9-48, 9% of the cases the polytrauma management was altered after prehospital ultrasound. A high diagnostic accuracy of prehospital ultrasound was found, with high sensitivity and specificity. Since all included studies reported a change in polytrauma management, this suggests a positive influence of prehospital ultrasound for polytrauma patients. Abstract: Introduction: Emergency ultrasound methods such as Focused Assessment with Sonography in Trauma (FAST) are a widely used imaging method. This examination can be performed to examine the presence of several life-threatening injuries. Early diagnosis may lead to better outcome, but the effect of timely diagnosis in the prehospital setting is not yet clear. Therefore, the aim is to determine the diagnostic accuracy and the effect of prehospital ultrasound performed in (poly)trauma patients. Methods: A literature search was performed in PubMed, Embase and Cochrane's Library. Articles were included if prehospital ultrasound was performed as a diagnostic intervention in patients with trauma. The main outcome measures included diagnostic accuracy, changes in prehospital diagnosis/treatment, changes in destination hospital and in-hospital response. Case reports and case series were excluded. Results: After screening 3343 articles, nine studies met the inclusion criteria. These included three retrospective and six prospective observational studies, with a total number of 2, 889 patients. Five studies report at least one change in polytrauma management, ranging from 6% to 48, 9% of the cases. The diagnostic accuracy of prehospital ultrasound was adequate in eight (out of nine) articles. High sensitivity and high specificity were found on several endpoints (pneumothorax, free abdominal fluid, haemoperitoneum, both on site and during transport). Conclusion: Prehospital ultrasound led to a change in polytrauma management in all studies that included this as an outcome measure. The diagnostic accuracy was described in eight studies, high sensitivity and specificity were found. Overall, the studies seem to suggest a positive influence of performing ultrasound. However, additional research with homogenous accuracy endpoints and uniformly trained prehospital care providers is recommended.