Prager Ross, Sedgwick Colin, Lund Adam, Kim Daniel, Ho Ben, Stachura Maja, Gutman Samuel
1University of British Columbia,Vancouver,British Columbia,Canada.
2MD Undergraduate Program,University of British Columbia,Vancouver,British Columbia,Canada.
Prehosp Disaster Med. 2018 Oct;33(5):484-489. doi: 10.1017/S1049023X18000821. Epub 2018 Oct 1.
IntroductionPoint-of-Care Ultrasound (POCUS) has become an important diagnostic tool for hospital-based clinicians. This study assesses the role of POCUS at Pemberton Music Festival 2016 (Pemberton, British Columbia [BC], Canada), a remote mass gathering where physicians face limited resources, complex disposition decisions, and a dynamic clinical environment.
This study prospectively evaluated the impact of POCUS on patient diagnosis, management, and disposition based on the self-report of the study physicians. The authors hypothesized that having ultrasound available for use would aid in diagnostic and management decisions and would reduce the need to transfer patients off-site to other health care facilities, reducing impact on the acute health services in the host community.
A handheld ultrasound was available for use by physicians in the main medical tent. All participating physicians self-reported their training and comfort using POCUS. After each POCUS scan, physicians completed a survey and recorded the indication for use, scans performed, and impact on patient diagnosis, management, and disposition.
In total, POCUS was used on 28 of the 686 patients treated in the main medical tent; POCUS was reported to narrow the differential diagnosis in 64% of cases and altered the working diagnosis in 21% of cases. Its use changed the management plan in 39% of patients. Its use was reported to reduce the burden on broader health care resource utilization in 46% of cases and prevented ambulance transport off-site in 32% of cases (nine cases in total). This corresponded to an absolute risk reduction of 1.3% for the percentage of patients transferred to hospital (PPTH; relative risk reduction of 53%).
Physicians reported that POCUS improved the diagnosis, management, and disposition of select patients at a remote, multi-day music festival. Also, POCUS reduced ambulance transfers off-site and reduced the perceived burden on broader health care utilization. PragerR, SedgwickC, LundA, KimD, HoB, StachuraM, GutmanS. Prospective evaluation of point-of-care ultrasound at a remote, multi-day music festival. Prehosp Disaster Med. 2018;33(5):484-489.
引言
床旁超声（POCUS）已成为医院临床医生的重要诊断工具。本研究评估了POCUS在2016年彭伯顿音乐节（加拿大不列颠哥伦比亚省[BC]彭伯顿）中的作用，这是一个偏远地区的大型集会，医生面临资源有限、处置决策复杂以及临床环境动态变化等情况。
本研究基于参与研究的医生的自我报告，前瞻性评估了POCUS对患者诊断、管理和处置的影响。作者假设，配备超声有助于诊断和管理决策，并减少将患者转至其他医疗机构的需求，从而减轻对主办社区急性医疗服务的影响。
在主医疗帐篷中，医生可使用手持超声。所有参与的医生自我报告他们使用POCUS的培训情况和熟练程度。每次POCUS扫描后，医生完成一份调查问卷，并记录使用指征、进行的扫描以及对患者诊断、管理和处置的影响。
在主医疗帐篷治疗的686名患者中，共有28名使用了POCUS；据报告，POCUS使64%的病例鉴别诊断范围缩小，21%的病例改变了初步诊断。其使用改变了39%患者的管理计划。据报告，其使用在46%的病例中减轻了对更广泛医疗资源利用的负担，在32%的病例中（共9例）避免了患者转送至场外。这相当于转院患者百分比（PPTH）的绝对风险降低了1.3%（相对风险降低53%）。
医生报告称，POCUS改善了在偏远的多日音乐节中部分患者的诊断、管理和处置。此外，POCUS减少了场外救护车转运，并减轻了对更广泛医疗利用的感知负担。普拉格R、塞奇威克C、伦德A、金D、何B、斯塔胡拉M、古特曼S。在偏远的多日音乐节中对床旁超声的前瞻性评估。院前灾难医学。2018；33(5):484 - 489。
