Page 155 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

Abdominal prehospital ultrasound impacts treatment decisions in a Dutch helicopter emergency medical service 153
proved our study and decided it to be exempt from further formal ethical review (2017-3123).
The primary objective was to identify treatment impacted by abdominal PHUS. Secondary objectives were to identify trauma mechanisms and illnesses for which abdominal PHUS was used and to calculate the diagnostic performance of PHUS.
Data collection and analysis
From the HEMS database, all patients who underwent at least one abdominal PHUS exam- ination were selected. Extracted data included patient demographics (sex, age, and estimated weight), trauma mechanism or illness, PHUS-specific notes (including PHUS timing, ab- dominal findings, and impact on patient care) and the physicians’ narrative report. This data set was imported into a secured Castor database (Ciwit B.V., Amsterdam, the Netherlands) that is compliant with Good Clinical Practice guidelines and allows for audit trails.
In the HEMS database, it is allowed, but not required, to add PHUS-specific notes and its impact on treatment. Alternatively, PHUS results and impact on treatment may be included in the narrative report. Whenever PHUS-specific notes were missing, two researchers (JH and RK) independently reviewed the EMR, including all available data, notes, and the nar- rative report, to identify any impacts on patient treatment. Whenever individual judgments differed between researchers, the case was discussed using a strict set of pre-defined criteria. Specific impacts after PHUS were scored and categorized. Questionable cases were again independently scored and subsequently discussed.
In many cases, a complete sonographic examination was performed, also including the chest and pericardium. Impacted treatment as a result of PHUS of other regions than the abdo- men was excluded.
To calculate diagnostic performance of PHUS, hospital EMRs of every patient transported to our trauma center (Radboudumc) were reviewed. CT scan and laparotomy reports were scrutinized for the presence of free abdominal fluid while being blinded to the PHUS results.
To look for a difference of the timing of PHUS on its diagnostic performance two groups were defined: an early group (PHUS upon arrival or during treatment) and a late group (PHUS during transport or upon arrival at the hospital). Since no exact PHUS times were recorded in the database, a fifth category (just before departure) could both qualify as an early or late timing and was therefore not included in either group.
The duration of patient contact was the interval between HEMS team arrival on-scene and
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