Page 158 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

Type of impacted treatment
n (%)
156
Chapter 7
Table 7.2 Decisions impacted by abdominal prehospital ultrasound
Fluid management
Aggressive (including packed red cells and hypertonic saline) Restrictive
Notification to the receiving hospital Trauma team consultation/preparation Packed red blood cells preparation Additional imaging requested
Scoop & run tactics Mode of transportation
By ambulance, not escorted by physician By ambulance, escorted by physician Vehicle change (helicopter vs ambulance)
Choice of destination hospital
To a lower-level hospital
To a higher-level hospital (trauma center)
Medication administration Unknown
Total
29 (11.6) 20 (8.0) 9 (3.6) 114 (45.4) 19 (7.6) 15 (6.0) 80 (31.9) 5 (2.0) 59 (23.5) 53 (21.1) 2 (0.8) 4 (1.6) 33 (13.1) 20 (8.0) 13 (5.2) 2 (0.8) 9 (3.6) 251 (100)
Note: impact on medication consisted of the administration of phenylephrine (vasoconstrictor).
Secondary outcomes
The trauma mechanisms and illnesses for which PHUS was performed are shown in Table 7.3. An overview of trauma mechanisms and illnesses in the entire base population treated in the 10-year study period is displayed in Table 7.4 and Figure 7.2. The main trauma mech- anisms are RTAs (68.3%) and falls from heights (16.7%). No significant difference in trauma mechanisms or illnesses between the Radboudumc and non-Radboudumc subpopulations was found (p = .374). Car and cargo truck drivers suffering accidents did not wear their safety belts in 577 (48.2%) of the cases.
Sensitivity and specificity of PHUS for free abdominal fluid was 31.3% and 96.7% respectively. Positive predictive value and negative predictive value were 72.9% and 83.0%. Diagnostic ac- curacy was 82.1%. In 39 of 53 cases when patient care was transferred to ground ambulances, data on follow-up was available in the HEMS database. In 39 (100%), in-hospital imaging results matched our PHUS findings (1 true positive and 38 true negatives).