Press Gregory M, Miller Sara K, Hassan Iman A, Alade Kiyetta H, Camp Elizabeth, Junco Deborah Del, Holcomb John B
Department of Emergency Medicine, University of Texas Medical School at Houston, Houston, Texas.
Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas.
J Emerg Med. 2014 Dec;47(6):638-45. doi: 10.1016/j.jemermed.2014.07.056. Epub 2014 Oct 1.
Ultrasound is widely considered the initial diagnostic imaging modality for trauma. Preliminary studies have explored the use of trauma ultrasound in the prehospital setting, but the accuracy and potential utility is not well understood.
We sought to determine the accuracy of trauma ultrasound performed by helicopter emergency medical service (HEMS) providers.
Trauma ultrasound was performed in flight on adult patients during a 7-month period. Accuracy of the abdominal, cardiac, and lung components was determined by comparison to the presence of injury, primarily determined by computed tomography, and to required interventions.
HEMS providers performed ultrasound on 293 patients during a 7-month period, completing 211 full extended Focused Assessment with Sonography for Trauma (EFAST) studies. HEMS providers interpreted 11% of studies as indeterminate. Sensitivity and specificity for hemoperitoneum was 46% (95% confidence interval [CI] 27.1%-94.1%) and 94.1% (95% CI 89.2%-97%), and for laparotomy 64.7% (95% CI 38.6%-84.7%) and 94% (95% CI 89.2%-96.8%), respectively. Sensitivity and specificity for pneumothorax were 18.7% (95% CI 8.9%-33.9%) and 99.5% (95% CI 98.2%-99.9%), and for thoracostomy were 50% (95% CI 22.3%-58.7%) and 99.8% (98.6%-100%), respectively. The positive likelihood ratio for laparotomy was 10.7 (95% CI 5.5-21) and for thoracostomy 235 (95% CI 31-1758), and the negative likelihood ratios were 0.4 (95% CI 0.2-0.7) and 0.5 (95% CI 0.3-0.8), respectively. Of 240 cardiac studies, there was one false-positive and three false-negative interpretations (none requiring intervention).
HEMS providers performed EFAST with moderate accuracy. Specificity was high and positive interpretations raised the probability of injury requiring intervention. Negative interpretations were predictive, but sensitivity was not sufficient for ruling out injury.
超声被广泛认为是创伤的初始诊断成像方式。初步研究已探讨了创伤超声在院前环境中的应用，但对其准确性和潜在效用尚未完全了解。
我们试图确定直升机紧急医疗服务（HEMS）提供者进行的创伤超声检查的准确性。
在7个月的时间里，对成年患者在飞行过程中进行创伤超声检查。通过与损伤的存在情况（主要由计算机断层扫描确定）以及所需干预措施进行比较，确定腹部、心脏和肺部检查部分的准确性。
在7个月的时间里，HEMS提供者对293名患者进行了超声检查，完成了211项完整的扩展创伤超声重点评估（EFAST）研究。HEMS提供者将11%的研究解释为不确定。腹腔积血的敏感性和特异性分别为46%（95%置信区间[CI]27.1%-94.1%）和94.1%（95%CI 89.2%-97%），剖腹手术的敏感性和特异性分别为64.7%（95%CI 38.6%-84.7%）和94%（95%CI 89.2%-96.8%）。气胸的敏感性和特异性分别为18.7%（95%CI 8.9%-33.9%）和99.5%（95%CI 98.2%-99.9%），胸腔造口术的敏感性和特异性分别为50%（95%CI 22.3%-58.7%）和99.8%（98.6%-100%）。剖腹手术的阳性似然比为10.7（95%CI 5.5-21），胸腔造口术的阳性似然比为235（95%CI 31-1758），阴性似然比分别为0.4（95%CI 0.2-0.7）和0.5（95%CI 0.3-0.8）。在240项心脏检查中，有1例假阳性和3例假阴性解释（均无需干预）。
HEMS提供者进行的EFAST检查准确性中等。特异性较高，阳性解释增加了需要干预的损伤的可能性。阴性解释具有预测性，但敏感性不足以排除损伤。
