Prehospital ultrasound in the management of trauma patients: Systematic review of the literature

Laura van der Weide; Zar Popal; Maartje Terra; Lothar A Schwarte; Johannes C F Ket; Fabian O Kooij; Aristomenis K Exadaktylos; Wietse P Zuidema; Georgios F Giannakopoulos

doi:10.1016/j.injury.2019.09.034

Prehospital ultrasound in the management of trauma patients: Systematic review of the literature

Injury. 2019 Dec;50(12):2167-2175. doi: 10.1016/j.injury.2019.09.034. Epub 2019 Sep 28.

Authors

Laura van der Weide¹, Zar Popal², Maartje Terra², Lothar A Schwarte³, Johannes C F Ket⁴, Fabian O Kooij⁵, Aristomenis K Exadaktylos⁶, Wietse P Zuidema², Georgios F Giannakopoulos²

Affiliations

¹ Department of Trauma Surgery, Amsterdam University Medical Centres, location VUmc, De Boelelaan 1117, 1081 HV, the Netherlands. Electronic address: l.vanderweide1@amsterdamumc.nl.
² Department of Trauma Surgery, Amsterdam University Medical Centres, location VUmc, De Boelelaan 1117, 1081 HV, the Netherlands.
³ Department of Anesthesiology, Amsterdam University Medical Centres, location VUmc, the Netherlands.
⁴ Medical Library, Vrije Universiteit, Amsterdam, the Netherlands.
⁵ Department of Anesthesiology, Amsterdam University Medical Centres, location AMC, the Netherlands.
⁶ Department of Emergency Medicine, Inselspital, University Hospital of Bern, Switzerland.

PMID: 31627899
DOI: 10.1016/j.injury.2019.09.034

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.

Keywords: Focused assessment with sonography in trauma (FAST); Prehospital; Trauma patients; Ultrasound.

Publication types

Systematic Review

MeSH terms

Early Diagnosis
Emergency Medical Services / methods*
Humans
Multiple Trauma / diagnosis*
Sensitivity and Specificity
Time-to-Treatment
Ultrasonography / methods*