Page 157 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

Abdominal prehospital ultrasound impacts treatment decisions in a Dutch helicopter emergency medical service 155
Results
The study Consort diagram is shown in Figure 7.1. In the 10-year study period, 1583 patients underwent 1631 abdominal PHUS examinations since some patients were examined twice. After excluding missing data, 1495 patients (1539 US examinations) were analyzed. In 970 cases, PHUS-specific notes were missing in the database and were independently reviewed as described above. Inter-rater reliability was 87.5%, and eventually, consensus was reached in all cases.
The mean age was 40.5 years (median 39, mode 21), and 29.8% were under 25. Young (male) adults were overrepresented. Demographics are displayed in Table 7.1.
Table 7.1
Age (years) Gender
Male
Female
Estimated weight (kg) Total
Demographics
Demographics
n (%)
Mean ± SD
Median (IQR)
Range
1558 (98.4)
1234 (78) 349 (22) 1315 (83.1) 1583 (100)
40.5 ± 20.1
78.8 ± 18.6
39 (23–54) 0–93
80 (70–90) 5–150
SD, standard deviation; IQR, interquartile range.
Primary outcome
In total 251 impacts on treatment were found in 194 of 1539 PHUS examinations (12.6%, 95% CI: 10.9, 14.3), concerning 188 of 1495 patients (12.6%). PHUS most frequently impacted: information provided to the destination hospital (45.4%); mode of transportation (23.5%); choice of destination hospital (13.1%) and fluid management (11.6%). Affected treatment is displayed in Table 7.2.
We identified a scale down subgroup of PHUS examinations that impacted or supported decisions in which patients were either transferred to a lower level hospital or were not escorted by a physician. This subgroup includes 73 of 251 (29.1%) decisions in 62 of 1539 exam- inations (4.0%) and 62 of 1495 patients (4.1%).
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