Page 152 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

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Chapter 7
Abstract
Objective:
To determine the impact of abdominal prehospital ultrasound (PHUS) on patient care in a Dutch physician-staffed helicopter emergency medical service (HEMS) and to determine its diagnostic performance.
Methods
We conducted a retrospective analysis of abdominal ultrasound examinations performed by the HEMS of Nijmegen, the Netherlands, from January 2007 until December 2016. Data including patient demographics, type of incident, abdominal ultrasound findings, impact on treatment decisions, and the physicians’ narrative report were retrieved from the HEMS database and analyzed. PHUS diagnostic performance was compared with computed tomog- raphy scan or laparotomy.
Results
Of 17077 recorded scrambles and 8699 patients treated, 1583 underwent 1631 abdominal ultrasound examinations. After eliminating missing data, 251 impacts on treatment in 194 out of 1539 PHUS examinations were identified (12.6%, 95% CI: 10.9, 14.3). This affected 188 out of 1495 (12.6%) patients. The four main categories of treatment decisions impacted by PHUS were: information provided to the destination hospital (45.4%); mode of transporta- tion (23.5%); choice of destination hospital (13.1%) and fluid management (11.6%). Sensitivity of prehospital abdominal ultrasound for hemoperitoneum was 31.3%, specificity 96.7%, and accuracy 82.1%.
Conclusions
Abdominal PHUS in our setting impacts treatment decisions significantly. Therefore, it is a valuable tool in the Dutch HEMS setting, and probably beyond.