Ambulance Victoria, Doncaster, Victoria, Australia.
Department of Paramedicine, Monash University, Frankston, Victoria, Australia.
Prehosp Emerg Care. 2023;27(6):800-806. doi: 10.1080/10903127.2022.2107123. Epub 2022 Aug 29.
Respiratory distress is a common presentation attended by paramedics. Chest auscultation has been shown to have low accuracy for diagnosing respiratory complaints, and this can lead to inaccurate patient assessment and potentially poor patient outcomes. Conversely, lung ultrasound is a relatively simple exam allowing for rapid differentiation of respiratory complaints with comparable accuracy to more advanced imaging modalities. Evidence suggests that lung ultrasound is easy to learn and apply and could be ideal for assessment of respiratory illness by paramedics.
This study aimed to explore the utility of out-of-hospital lung ultrasound performed by intensive care paramedics (ICP) for patients with medical causes of respiratory distress, and explore whether the use of lung ultrasound affects the ICP's clinical impression or management.
This was a prospective observational pilot study. After a training program, a sample of ICPs working in metropolitan and regional Victoria, Australia used ultrasound to assess adult patients with respiratory distress and/or dyspnea. ICPs used a handheld point-of-care ultrasound device to scan respiratory patients using a modified protocol, and completed a worksheet with their scan findings. The scans were then reviewed by a subject matter expert for quality and agreement.
Ninety-five patients were enrolled over the study period. The average image quality score was 2.68/5, and 56% of scans were of interpretable quality. Interrater agreement (between the ICPs and the subject matter expert) was reported using Cohen's kappa. Moderate overall agreement (0.44) was shown, with the highest reliability reported in A-profile and B-profile (0.49 and 0.57). In 42% of cases performance of the scan affected paramedic clinical impression and/or management.
ICPs can perform lung ultrasound with moderate accuracy for some respiratory conditions, and the scans may affect clinical impression and management. Future research should focus on enhanced education, expert feedback, and clinical outcomes.
呼吸窘迫是急救人员常见的表现。听诊已被证明对诊断呼吸投诉的准确性较低，这可能导致不准确的患者评估和潜在的不良患者结果。相比之下，肺部超声是一种相对简单的检查，可以快速区分呼吸投诉，其准确性与更先进的成像方式相当。有证据表明，肺部超声易于学习和应用，对于急救人员评估呼吸疾病可能是理想的选择。
本研究旨在探讨重症监护急救人员（ICP）进行院外肺部超声检查对因医学原因导致呼吸窘迫的患者的实用性，并探讨肺部超声的使用是否会影响 ICP 的临床印象或管理。
这是一项前瞻性观察性试点研究。在培训计划后，澳大利亚大都市和地区的一组 ICP 使用超声评估患有呼吸窘迫和/或呼吸困难的成年患者。ICP 使用手持式即时护理超声设备按照修改后的方案扫描呼吸患者，并在工作表上记录他们的扫描结果。然后由主题专家对扫描进行质量和一致性审查。
在研究期间共纳入了 95 名患者。平均图像质量评分为 2.68/5，56%的扫描具有可解释的质量。报告了 ICP 与主题专家之间的组内一致性（用 Cohen's kappa 表示）。显示出中度总体一致性（0.44），在 A 型和 B 型剖面中报告了最高的可靠性（0.49 和 0.57）。在 42%的情况下，扫描的表现会影响急救人员的临床印象和/或管理。
ICP 可以对某些呼吸状况进行中等准确性的肺部超声检查，并且扫描可能会影响临床印象和管理。未来的研究应侧重于增强教育、专家反馈和临床结果。
