Utilization Criteria for Prehospital Ultrasound in a Canadian Critical Care Helicopter Emergency Medical Service: Determining Who Might Benefit

作者：O'Dochartaigh Domhnall^*; Douma Matthew; Alexiu Chris; Ryan Shell; MacKenzie Mark

来源：Prehospital and Disaster Medicine, 2017, 32(5): 536-540.

DOI：10.1017/S1049023X1700646X

• air ambulance
• FAST
• HEMS
• POCUS
• ultrasound

Introduction: Prehospital ultrasound (PHUS) assessments by physicians and non-physicians are performed on medical and trauma patients with increasing frequency. Prehospital ultrasound has been shown to be of benefit by supporting interventions.
Problem: Which patients may benefit from PHUS has not been clearly identified.
Methods: A multi-variable logistic regression analysis was performed on a previously created retrospective dataset of five years of physician- and non-physician-performed ultrasound scans in a Canadian critical care Helicopter Emergency Medical Service (HEMS). For separate medical and trauma patient groups, the a-priori outcome assessed was patient characteristics associated with the outcome variable of "PHUS-supported intervention."
Results: Both models were assessed (Likelihood Ratio, Score, and Wald) as a good fit. For medical patients, the characteristics of heart rate (HR) and shock index (SI) were found to be most significant for an intervention being supported by PHUS. An extremely low HR was found to be the most significant (OR = 15.86 [95% confidence interval (CI), 1.46-171.73]; P = .02). The higher the SI, the more likely that an intervention was supported by PHUS (SI 0.9 to < 1.3: OR = 9.15 [95% CI, 1.36-61.69]; P = .02; and SI 1.3 + : OR = 8.37 [95% CI, 0.69-101.66]; P = .09). For trauma patients, the characteristics of Prehospital Index (PHI) and SI were found to be most significant for PHUS support. The greatest effect was PHI, where increasing ORs were seen with increasing PHI (PHI 14-19: OR = 13.36 [95% CI, 1.92-92.81]; P = .008; and PHI 20-24: OR = 53.10 [95% CI, 4.83-583.86]; P = .001). Shock index was found to be similar, though, with lower impact and significance (SI 0.9 to < 1.3: OR = 9.11 [95% CI, 1.31-63.32]; P = .025; and SI 1.3 + : OR = 35.75 [95% CI, 2.51-509.81]; P = .008).
Conclusions: In a critical care HEMS, markers of higher patient acuity in both medical and trauma patients were associated with occurrences when an intervention was supported by PHUS. Prospective study with in-hospital follow-up is required to confirm these hypothesis-generating results.