Taheri Omide, Samain Julie, Mauny Frédéric, Puyraveau Marc, Desmettre Thibaut, Marx Tania
Emergency Department, CHU Besançon, Besançon, France.
Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, Besançon, France.
Eur J Emerg Med. 2025 Apr 1;32(2):87-99. doi: 10.1097/MEJ.0000000000001205. Epub 2024 Dec 3.
Acute dyspnea is a common symptom whose management is challenging in prehospital settings. Point-of-care ultrasound (POCUS) is increasingly accessible because of device miniaturization. To assess the contribution of POCUS in the prehospital management of patients with acute nontraumatic dyspnea, we performed a systematic review on nontrauma patients of any age managed in the prehospital setting for acute dyspnea and receiving a POCUS examination. We searched seven databases and gray literature for English-language studies published from January 1995 to November 2023. Two independent reviewers completed the study selection, data extraction, and risk of bias assessment. The primary outcome was the assessment of the contribution of POCUS to feasibility, diagnostic, therapeutic, prognosis, patient referral, and transport vector modification. Twenty-three studies were included. The risk of bias assessment identified 3 intermediate-risk, 18 serious-risk, and 2 critical-risk studies. Three studies reported moderate to excellent feasibility for lung POCUS, and three studies reported poor to mediocre feasibility for cardiac POCUS. The median duration of the POCUS examination was less than 5 minutes (six studies). POCUS improved diagnostic identification (seven studies). The diagnostic accuracy of POCUS was excellent for pneumothorax (sensitivity = 100%, specificity = 100%, two studies), very good for acute heart failure (sensitivity = 71-100%, specificity = 72-95%, eight studies), good for pneumonia (sensitivity = 88%, specificity = 59%, one study), and moderate for pleural effusion (sensitivity = 26-53%, specificity = 83-92%, two studies). Treatment was modified in 11 to 54% of the patients (seven studies). POCUS had no significant effect on patient prognosis (two studies). POCUS contributed to patient referrals and transport vectors in 51% (four studies) and 25% (three studies) of patients, respectively. The evidence supports the use of POCUS for managing acute nontraumatic dyspnea in the prehospital setting in terms of feasibility, overall diagnostic contribution, and, particularly, lung ultrasound for acute heart failure diagnosis. Moreover, POCUS seems to have a therapeutic contribution. There is not enough evidence supporting the use of POCUS for pneumonia, pleural effusion, pneumothorax, chronic obstructive pulmonary disease, or asthma exacerbation diagnosis, nor does it support prognostic, patient referral, and transport vector contribution. A high level of evidence is lacking and needed.
急性呼吸困难是一种常见症状，其在院前环境中的处理具有挑战性。由于设备小型化，床旁超声（POCUS）越来越容易获得。为了评估POCUS在急性非创伤性呼吸困难患者院前管理中的作用，我们对在院前环境中因急性呼吸困难接受POCUS检查的任何年龄的非创伤患者进行了系统评价。我们检索了7个数据库和灰色文献，以查找1995年1月至2023年11月发表的英文研究。两名独立评审员完成了研究选择、数据提取和偏倚风险评估。主要结果是评估POCUS对可行性、诊断、治疗、预后、患者转诊和运输载体调整的作用。纳入了23项研究。偏倚风险评估确定3项中度风险、18项严重风险和2项关键风险研究。3项研究报告肺POCUS的可行性为中度至极佳，3项研究报告心脏POCUS的可行性为差至中等。POCUS检查的中位持续时间少于5分钟（6项研究）。POCUS改善了诊断识别（7项研究）。POCUS对气胸的诊断准确性极佳（敏感性 = 100%，特异性 = 100%，2项研究），对急性心力衰竭非常好（敏感性 = 71 - 100%，特异性 = 72 - 95%，8项研究），对肺炎良好（敏感性 = 88%，特异性 = 59%，1项研究），对胸腔积液中等（敏感性 = 26 - 53%，特异性 = 83 - 92%，2项研究）。11%至54%的患者治疗得到调整（7项研究）。POCUS对患者预后无显著影响（2项研究）。POCUS分别对51%（4项研究）和25%（3项研究）的患者转诊和运输载体有贡献。证据支持在院前环境中使用POCUS来管理急性非创伤性呼吸困难，在可行性、总体诊断贡献方面，特别是肺超声对急性心力衰竭的诊断。此外，POCUS似乎具有治疗作用。没有足够的证据支持使用POCUS来诊断肺炎、胸腔积液、气胸、慢性阻塞性肺疾病或哮喘急性发作，也不支持其对预后、患者转诊和运输载体的贡献。缺乏且需要高水平的证据。
