Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA.
Victoria Emergency Associates, Austin, TX 78704, USA.
Mil Med. 2024 Aug 30;189(9-10):e2242-e2247. doi: 10.1093/milmed/usae219.
The integration of Point of Care Ultrasound (POCUS) into the care of trauma patients, specifically the E-FAST, has improved the accuracy of initial diagnoses and improved time to surgical intervention in critically ill patients. Physician assistants (PAs) are critically important members of any military trauma resuscitation team and are often team leaders in a pre-hospital setting. They may receive training in ultrasound but there are little data to support their use or evaluate their effectiveness in using POCUS. We designed a study to evaluate the image quality of an E-FAST Exam performed by Emergency Medicine Physician Assistant (EMPA) Fellows and Emergency Medicine (EM) Interns following identical training. Our hypothesis is that image quality obtained by EMPAs will be non-inferior to those images obtained by EM Interns.
This is a prospective single-blinded study comparing the image quality of E-FAST exams performed by first year EM interns and first year EMPA fellows. All participants completed standard POCUS training prior to enrollment in the study. A total of 8 EMPAs and 8 EM first year residents completed 10 recorded E-FAST exams to be used as study images. Participants also viewed a 15-question slide show containing images of positive (6) and negative (9) E-FAST exams and recorded their interpretations. Images were reviewed by expert reviewers who were blinded to which images were collected by which group. An image quality score was recorded for each view as well as an overall image quality score. Image quality was rated on a 1 to 5 image quality scale.
For overall image quality, the mean score for EMPAs was 3.6 ± 0.5 and for EM residents was 3.2 ± 0.5 with statistical significance favoring better image quality from the EMPAs. The time to completion for the EFAST exam for EMPAs was 4.8 ± 1.3 minutes and for interns it was 3.4 ± 1.4 minutes (P value = 0.02). There was no difference in image interpretation quiz scores between the groups (mean score 92% among interns and 95% among PAs).
POCUS is an imaging modality which is very portable and relatively inexpensive which makes it ideal for military medicine. PAs are essential members of military trauma teams, and often run an initial trauma resuscitation. Being able to correctly identify patients who have free fluid early in the course of treatment allows for more correct evacuation criteria to ensure the sickest patients get to care the fastest. Although there are limited data to support POCUS use by non-physicians, our data support a growing body of evidence that it is not the profession or baseline medical education that determines an individual's ability to use and incorporate ultrasound into bedside and clinical practice. Our study shows that with training and experience PAs or other members of the military health care team can use the EFAST to better care for trauma patients.
将即时护理超声（POCUS）融入创伤患者的护理中，特别是 E-FAST，提高了危急患者初始诊断的准确性，并缩短了手术干预的时间。医师助理（PA）是任何军事创伤复苏团队中至关重要的成员，他们通常是院前环境中的团队领导者。他们可能接受过超声培训，但几乎没有数据支持他们使用 POCUS 或评估他们使用 POCUS 的效果。我们设计了一项研究，以评估接受相同培训的急诊医学医师助理（EMPA）研究员和急诊医学（EM）住院医师进行的 E-FAST 检查的图像质量。我们的假设是，EMPA 获得的图像质量将不亚于 EM 住院医师获得的图像质量。
这是一项前瞻性单盲研究，比较了第一年 EM 住院医师和第一年 EMPA 研究员进行的 E-FAST 检查的图像质量。所有参与者在参加研究前都完成了标准的 POCUS 培训。共有 8 名 EMPA 和 8 名 EM 第一年住院医师完成了 10 次记录的 E-FAST 检查，作为研究图像。参与者还观看了包含 6 个阳性（6）和 9 个阴性（9）E-FAST 检查图像的 15 个问题幻灯片，并记录了他们的解释。图像由专家评审员进行评估，评审员对哪些图像是由哪个组收集的情况进行了盲评。为每个视图记录了图像质量评分以及总体图像质量评分。图像质量按 1 到 5 的图像质量评分进行评分。
总体图像质量方面，EMPA 的平均得分为 3.6±0.5，EM 住院医师的平均得分为 3.2±0.5，EMPA 的图像质量更好，具有统计学意义。EMPA 完成 EFAST 检查的时间为 4.8±1.3 分钟，住院医师为 3.4±1.4 分钟（P 值=0.02）。两组在图像解读测验分数上没有差异（住院医师的平均分数为 92%，PA 为 95%）。
POCUS 是一种非常便携且相对便宜的成像方式，非常适合军事医学。PA 是军事创伤团队的重要成员，通常负责进行初始创伤复苏。能够及早正确识别有游离液体的患者，可以更准确地确定清除标准，以确保病情最重的患者尽快得到治疗。尽管支持非医生使用 POCUS 的数据有限，但我们的数据支持越来越多的证据，即不是专业或基线医学教育决定了个人使用和将超声纳入床边和临床实践的能力。我们的研究表明，经过培训和经验，PA 或其他军队卫生保健团队成员可以使用 EFAST 更好地治疗创伤患者。
