Fitzgerald Emily, Parker Shelby, Hancock Sarah, Jones Courtney Marie-Cora, Kittel Julie, DeAngelis John, Dorsett Maia
Department of Emergency Medicine University of Rochester Rochester New York USA.
Department of Emergency Medicine University of Pittsburgh Pittsburgh Pennsylvania USA.
J Am Coll Emerg Physicians Open. 2024 Apr 16;5(2):e13164. doi: 10.1002/emp2.13164. eCollection 2024 Apr.
Patients with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) exacerbations present with similar history and physical examination findings. This complicates both the diagnostic process and the creation of appropriate treatment plans for patients presenting in respiratory distress, particularly in the prehospital setting. Thoracic point-of-care-ultrasound (POCUS) may increase diagnostic accuracy; however, its potential to improve patient management by emergency medical services clinicians is unknown. We aimed to determine whether a brief thoracic POCUS educational intervention would improve prehospital diagnostic accuracy and treatment plans for patients with COPD and CHF exacerbations.
In this prospective pre-/post-study, paramedics completed a thoracic POCUS training program. The pre-test presented history and physical examination data for 10 patients and asked paramedics to diagnose each patient with COPD or CHF exacerbation and to select the appropriate treatment(s). The post-test asked paramedics to interpret ultrasound images in addition to selecting diagnosis and treatment(s). Pre-post differences in average cumulative diagnostic and management accuracy were analyzed using paired two-tailed -tests.
Thirty-three paramedics participated in the study. At baseline, paramedics selected the accurate patient diagnosis and treatment(s) 73% and 60% of the time, respectively. On the post-test, diagnostic accuracy improved by 17% (95% confidence interval [CI]: 11-24, < 0.001) and appropriate treatment selection improved by 23% (95% CI: 16-28, < 0.001). Paramedics correctly interpreted ultrasound images 90% of the time.
Effective training of paramedics to recognize the clinical scenario of undifferentiated respiratory distress and their associated thoracic ultrasound images may lead to improved treatment plans.
慢性阻塞性肺疾病（COPD）和充血性心力衰竭（CHF）急性加重的患者具有相似的病史和体格检查结果。这使得对出现呼吸窘迫的患者进行诊断以及制定合适的治疗方案变得复杂，尤其是在院前环境中。胸部即时超声检查（POCUS）可能会提高诊断准确性；然而，急诊医疗服务临床医生利用其改善患者管理的潜力尚不清楚。我们旨在确定简短的胸部POCUS教育干预是否会提高COPD和CHF急性加重患者的院前诊断准确性和治疗方案。
在这项前瞻性的前后对照研究中，护理人员完成了一项胸部POCUS培训计划。预测试给出了10例患者的病史和体格检查数据，并要求护理人员诊断每位患者是否为COPD或CHF急性加重，并选择合适的治疗方法。后测试除了要求护理人员选择诊断和治疗方法外，还要求他们解读超声图像。使用配对双尾检验分析平均累积诊断和管理准确性的前后差异。
33名护理人员参与了该研究。在基线时，护理人员分别在73%和60%的时间内选择了准确的患者诊断和治疗方法。在后测试中，诊断准确性提高了17%（95%置信区间[CI]：11 - 24，P < 0.001），合适治疗方法的选择提高了23%（95% CI：16 - 28，P < 0.001）。护理人员在90%的时间内正确解读了超声图像。
对护理人员进行有效培训，使其能够识别未分化呼吸窘迫的临床情况及其相关的胸部超声图像，可能会改善治疗方案。
