Prehospital ultrasound of the abdomen and thorax changes trauma patient management: A systematic review.
BACKGROUND
Ultrasound examination of trauma patients is increasingly performed in prehospital services. It is unclear if prehospital sonographic assessments change patient management: providing prehospital diagnosis and treatment, determining choice of destination hospital, or treatment at the receiving hospital.


OBJECTIVE
This review aims to assess and grade the evidence that specifically examines whether prehospital ultrasound (PHUS) of the thorax and/or abdomen changes management of the trauma patient.


METHODS
A systematic review was conducted of trauma patients who had an ultrasound of the thorax or abdomen performed in the prehospital setting. PubMed, MEDLINE, Web of Science (CINAHL, EMBASE, Cochrane Central Register of Controlled Trials) and the reference lists of included studies were searched. Methodological quality was checked and risk of bias analysis performed, a level of evidence grade was assigned, and descriptive data analysis performed.


RESULTS
992 unique citations were identified, which included eight studies that met inclusion criteria with a total of 925 patients. There are no reports of randomised controlled trials. Heterogeneity exists between the included studies which ranged from a case series to retrospective and prospective non-randomised observational studies. Three studies achieved a 2+ Scottish Intercollegiate Guidelines Networks grade for quality of evidence and the remainder demonstrated a high risk of bias. The three best studies each provided examples of prehospital ultrasound positively changing patient management.


CONCLUSIONS
There is moderate evidence that supports prehospital physician use of ultrasound for trauma patients. For some patients, management was changed based on the results of the PHUS. The benefit of ultrasound use in non-physician services is unclear.
Air Medical Crew, Shock Trauma Air Rescue Society, Suite 100, 1519 35 Ave E, Edmonton Int'l Airport, Alberta T9E 0V6, Canada. Electronic address: domhnall13@hotmail.com.
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O'Dochartaigh
Clinical Nurse Educator, Emergency Services, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, Alberta T5H 3V9, Canada. Electronic address: matthew.douma@albertahealthservices.ca.
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Douma
D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D063868:Patient Outcome Assessment; D012017:Referral and Consultation; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014463:Ultrasonography
Air medical transport; EFAST; Emergency medical services; FAST; Helicopter; Prehospital; Sonography; Systematic review; Trauma; Ultrasound