Usefulness of hand-held ultrasound devices in out-of-hospital diagnosis performed by emergency physicians.
OBJECTIVE
To evaluate the usefulness of ultrasonographic examinations as a diagnostic tool for emergency physicians in out-of-hospital settings.


METHODS
Prospective study performed in a French teaching hospital. Eight emergency physicians given ultrasound training for out-of-hospital diagnosis of pleural, peritoneal, or pericardial effusion; deep venous thrombosis; and arterial flow interruption. After clinical examination, a probability of diagnosis ("clinical score") was assigned on visual analog scale from 0 (absent lesion) to 10 (present lesion). Clinical score between 3 and 7 was considered as clinically doubtful. After ultrasound examination, a second probability ("ultrasound score") was similarly determined. Potential usefulness of ultrasound examination was evaluated by calculating the absolute difference between clinical and ultrasound scores. Patients were followed up to determine final diagnosis: present or absent lesion. "Ultrasound usefulness score" (USS) was determined attributing a positive (when ultrasonography increased diagnostic accuracy) or a negative (when ultrasonography decreased diagnostic accuracy) value to the absolute difference between clinical and ultrasound scores.


RESULTS
One hundred sixty-nine patients were included and 302 ultrasound examinations performed. Median duration of examination was 6 minutes (5-10 minutes). The suspected lesion was found in 45 cases (17%). Mean USS was +2 (0-4). Ultrasonographic examination improved diagnostic accuracy (ie, positive USS) in 181 (67%) cases, decreased it (ie, negative USS) in 22 (8%) cases, and was not contributive (ie, USS was 0) in 67 (25%) cases. When initial diagnosis was uncertain (n = 115), diagnostic performance reached +4 (3-5) and ultrasonographic examination improved diagnostic accuracy in 103 (90%) cases.


CONCLUSIONS
Out-of-hospital ultrasonography increased diagnostic accuracy in out-of-hospital settings.
SAMU 93, UPRES 3409, Université Paris XIII, Hôpital Avicenne, Bobigny, France. frederic.lapostolle@avc.ap-hop-paris.fr
Frédéric
F
Lapostolle
Tomislav
T
Petrovic
Gilles
G
Lenoir
Jean
J
Catineau
Michel
M
Galinski
Jacques
J
Metzger
Erick
E
Chanzy
Frédérick
F
Adnet
D001202:Ascitic Fluid / Q000000981:diagnostic imaging; D004632:Emergency Medical Services / Q000379:methods; D004635:Emergency Medicine; D006801:Humans; D010490:Pericardial Effusion / Q000000981:diagnostic imaging; D010996:Pleural Effusion / Q000000981:diagnostic imaging; D019095:Point-of-Care Systems; D011446:Prospective Studies; D014463:Ultrasonography / Q000295:instrumentation*; D014652:Vascular Diseases / Q000000981:diagnostic imaging