Table 2 Included studies examining mixed patient populations or ultrasound for procedural guidance
From: The role of point of care ultrasound in prehospital critical care: a systematic review
First author, year | n | Study type | Aim | US types, providers | Main results | Rating |
|---|---|---|---|---|---|---|
Mixed populations | ||||||
Quick, 2016 | 149 patients | Controlled (prehospital paramedics vs in-hospital physicians) | To evaluate the ability of ability of in-flight thoracic US to identify pneumothorax (trauma and medical patients) | Lung (PTX), paramedics compared to ED physicians | Gold standard chest CT (n = 116). Prehospital sensitivity of 68% (95% CI 46–85), specificity 96% (95% CI 90–98), accuracy 91% (95% CI 85–95). Physician-based ED US; sensitivity 84% (95% CI 62–94), specificity 98% (95% CI 93–99), accuracy 96% (95% CI 90–98). | + |
O’Dochertaigh, 2017 | 455 missions | Cohort | To describe the use of US to support interventions when used by physicians and non-physicians (trauma and medical patients) | Trauma ultrasound and IVC, highly trained physicians and non-physicians (paramedics) | Interventions was supported in US in 26% (95% CI 18–34) of cases when used by non-physicians, and in 45% (95% CI 34–56) when used by physicians (p < 0.006) | 0 |
Roline, 2013 | 71 (41 scans) | Cohort | To evaluate the feasibility of bedside thoracic US (trauma and medical patients) | Lung (PTX), prehospital care providers (paramedics?) | In 71 eligible patients, 41 (58%) scans were completed. Level of agreement between flight crew and expert substantial with a kappa of 0.67, (95% CI 0.44–0.90). 54% of images were rated “good”. Causes for not completing US were lack of time or space limitation in aircraft. | + |
Ketelaars, 2013 | 281 patients, 326 exams | Cohort | To evaluate the impact of US chest examinations on the care of patients in a HEMS service (trauma and cardiac arrest patients) | Heart, lung (PTX), abdomen, experienced physicians | PTX sensitivity 38%, specificity 97%, PPV 90%, NPV 69%. Treatment plan changed in 60 (21%) patients; in 10 (4%) a chest tube was abandoned; in 10 (4%) the destination for definitive care was changed, in 9 (3%) cardiopulmonary resuscitation was stopped and in 31 (11%) there were other changes. | + |
Procedural guidance | ||||||
Chenaita, 2012 | 130 patients | Diagnostic accuracy | To estimate the diagnostic accuracy of US confirmation of gastric tube placement | Abdominal (gastric), experienced physicians | Sensitivity 98.3% (95% CI 94–99.5), specificity 100% (95% CI 75.7–100). PPV 100%, NPV 85.7%. Correlation between gastric tube size and visualization (larger tubes easier to see) | + |
Brun, 2014 | 32 | Controlled study (2-point US vs syringe test) | To estimate the diagnostic accuracy of 2-point US to confirm gastric tube placement | Esophageal, abdominal, physicians | 100% visualization of gastric tube in the esophagus, 62.5% in the stomach. X-ray confirmed 28/32 in correct position. US higher diagnostic accuracy than syringe test. | 0 |
Zadel, 2015 | 124 patients | Diagnostic accuracy | To assess the sensitivity and specificity of US for confirming endotracheal intubation | Lung (lung sliding and diaphragm excursion), certified physicians | Gold standard, capnography. US sensitivity 100%, specificity 100%, PPV 100%, NPV 100%. Median US time 30 s. | 0 |