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. 2021 Feb 25;29(1):40.
doi: 10.1186/s13049-021-00856-8.

Quality of focused thoracic ultrasound performed by emergency medical technicians and paramedics in a prehospital setting: a feasibility study

Pia Iben Pietersen  1   2 , Søren Mikkelsen  3 , Annmarie T Lassen  4 , Simon Helmerik  5 , Gitte Jørgensen  6 , Giti Nadim  4   7 , Helle Marie Christensen  8   9 , Daniel Wittrock  5 , Christian B Laursen  8   9
Affiliations

Quality of focused thoracic ultrasound performed by emergency medical technicians and paramedics in a prehospital setting: a feasibility study

Pia Iben Pietersen et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: In a prehospital setting, the severity of respiratory symptoms in patients calling for an ambulance differ. The initial evaluation, diagnosing, and thereby management can be challenging because respiratory symptoms can be caused by disease in many organs. Ultrasound examinations can contribute with important information and support the clinical decision-making. However, ultrasound is user-dependent and requires sufficient knowledge and training. The aim of this study was to explore the quality of thoracic ultrasound examinations performed on patients by emergency medical technicians and paramedics in a prehospital, clinical setting.

Methods: From November 2018 - April 2020, Danish emergency medical technicians and paramedics (n = 100) performed thoracic ultrasound examinations on patients with respiratory symptoms using a portable ultrasound device. The ultrasound examinations were stored and retrospectively assessed by a reviewer blinded to the patients' symptoms and history, as well as the emergency medical technicians' and paramedics' findings. The image quality was scored from 1 to 5. The findings determined by the reviewer was then correlated with a questionnaire filled out by the emergency medical technicians and paramedics regarding ultrasonic findings and potential change in treatment or management of the patient. The agreement in percentage and as Cohen's kappa was explored.

Results: A total of 590 ultrasound examinations were assessed, resulting in a median image quality score of 3 (IQ1 = 4, IQ3 = 3). The overall agreement in percentage between the emergency medical technicians and paramedics and reviewer was high (87.7% for a normal scan, 89.9% for interstitial syndrome, 97.3% for possible pneumothorax, and 96.3% for pleural effusion). Cohen's kappa varied from 0.01 for possible pneumothorax to 0.69 for pleural effusion. Based on the questionnaires (n = 406), the ultrasound examination entailed a change in treatment or visitation in 48 cases (11.7%) which in this study population encompasses a number-needed-to-scan of 8.5.

Conclusion: Emergency medical technicians and paramedics perform focused thoracic ultrasound examinations with adequate image quality sufficient to determine if pathology is present or not. The emergency medical technicians' and paramedics' assessment correlates to some extent with an experienced reviewer and their findings are most reliable for the inclusion of a normal scan or inclusion of pleural effusion. Implementation could possibly impact the number of patients receiving correct prehospital treatment and optimal choice of receiving facility.

Keywords: Prehospital ultrasound; Respiratory symptoms; Thoracic ultrasound.

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Conflict of interest statement

In relation to the project Annmarie Lassen’s research unit has received three months salary from Region of Southern Denmark for a research assistant and three months salary for data management from FALCK.

None of the authors have any conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Graphical presentation of scanning zones
Fig. 2
Fig. 2
Image quality scores
See this image and copyright information in PMC

References

    1. European Emergency Data (EED) Project EC . European Emergency Data Project - EMS Data-based Health Surveillance System. 2002. - PubMed
    1. Prekker ME, Feemster LC, Hough CL, et al. The epidemiology and outcome of prehospital respiratory distress. Acad Emerg Med. 2014;21:543–550. doi: 10.1111/acem.12380. - DOI - PMC - PubMed
    1. Kelly AM, Holdgate A, Keijzers G, et al. Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: an observational study. Scand J Trauma Resusc Emerg Med. 2016;24:113. doi: 10.1186/s13049-016-0305-5. - DOI - PMC - PubMed
    1. Ebrahimi A, Yousefifard M, Mohammad Kazemi H, et al. Diagnostic accuracy of chest ultrasonography versus chest radiography for identification of pneumothorax: a systematic review and meta-analysis. Tanaffos. 2014;13:29–40. - PMC - PubMed
    1. Wang Y, Shen Z, Lu X, et al. Sensitivity and specificity of ultrasound for the diagnosis of acute pulmonary edema: a systematic review and meta-analysis. Med Ultrason. 2018;1:32–36. doi: 10.11152/mu-1223. - DOI - PubMed

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