Contribution of point-of-care ultrasound in the prehospital management of patients with non-trauma acute dyspnea: a systematic review and meta-analysis.

Autor:	Taheri O; Emergency Department, CHU Besançon, Besançon, France.; Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, Besançon, France.; Université Franche-Comté, Besançon, France., Samain J; Emergency Department, CHU Besançon, Besançon, France., Mauny F; Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, Besançon, France.; Université Franche-Comté, Besançon, France.; UMETh - Centre Investigation Clinique 1431, CHU Besançon, Besançon, France., Puyraveau M; Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, Besançon, France.; Université Franche-Comté, Besançon, France.; UMETh - Centre Investigation Clinique 1431, CHU Besançon, Besançon, France., Desmettre T; Emergency Department, Hôpitaux Universitaires de Genève, Centre Médical Universitaire, Université de Genève, Genève, Switzerland., Marx T; Emergency Department, CHU Besançon, Besançon, France.; Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, Besançon, France.; Université Franche-Comté, Besançon, France.
Jazyk:	angličtina
Zdroj:	European journal of emergency medicine : official journal of the European Society for Emergency Medicine [Eur J Emerg Med] 2024 Dec 03. Date of Electronic Publication: 2024 Dec 03.
DOI:	10.1097/MEJ.0000000000001205
Abstrakt:	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. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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