Journal article
Prehospital ultrasound in the management of trauma patients: Systematic review of the literature.
- van der Weide L Department of Trauma Surgery, Amsterdam University Medical Centres, location VUmc, De Boelelaan 1117, 1081 HV, the Netherlands. Electronic address: l.vanderweide1@amsterdamumc.nl.
- Popal Z Department of Trauma Surgery, Amsterdam University Medical Centres, location VUmc, De Boelelaan 1117, 1081 HV, the Netherlands.
- Terra M Department of Trauma Surgery, Amsterdam University Medical Centres, location VUmc, De Boelelaan 1117, 1081 HV, the Netherlands.
- Schwarte LA Department of Anesthesiology, Amsterdam University Medical Centres, location VUmc, the Netherlands.
- Ket JCF Medical Library, Vrije Universiteit, Amsterdam, the Netherlands.
- Kooij FO Department of Anesthesiology, Amsterdam University Medical Centres, location AMC, the Netherlands.
- Exadaktylos AK Department of Emergency Medicine, Inselspital, University Hospital of Bern, Switzerland.
- Zuidema WP Department of Trauma Surgery, Amsterdam University Medical Centres, location VUmc, De Boelelaan 1117, 1081 HV, the Netherlands.
- Giannakopoulos GF Department of Trauma Surgery, Amsterdam University Medical Centres, location VUmc, De Boelelaan 1117, 1081 HV, the Netherlands.
- 2019-10-20
Published in:
- Injury. - 2019
Focused assessment with sonography in trauma (FAST)
Prehospital
Trauma patients
Ultrasound
Early Diagnosis
Emergency Medical Services
Humans
Multiple Trauma
Sensitivity and Specificity
Time-to-Treatment
Ultrasonography
English
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.
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.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.injury.2019.09.034
- PMID 31627899
- Persistent URL
- https://folia.unifr.ch/global/documents/284837
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