Point-of-care ultrasound for treatment and triage in austere military environments
| Autor: | Gabriel Morand, Pierre Mahe, Olivier Dubourg, Christophe Dubecq, Stéphane Travers, Romain Montagnon |
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| Rok vydání: | 2021 |
| Předmět: |
Delphi method
MEDLINE Critical Care and Intensive Care Medicine Middle East Injury Severity Score Blast Injuries medicine Humans Military Medicine Retrospective Studies Ultrasonography business.industry Point of care ultrasound Evidence-based medicine medicine.disease Triage Point-of-Care Testing Africa War-Related Injuries Surgery Observational study Wounds Gunshot Medical emergency France business Penetrating trauma |
| Zdroj: | The journal of trauma and acute care surgery. 91(2S Suppl 2) |
| ISSN: | 2163-0763 |
| Popis: | Background Assessment and triage in an austere environment represent a major challenge in casualty care. Modern conflicts involve a significant proportion of multiple wounds, either superficial or penetrating, which complicate clinical evaluation. Furthermore, there is often poor accessibility to computed tomography scans and a limited number of surgical teams. Therefore, ultrasound (US) represents a potentially valuable tool for distinguishing superficial fragments or shrapnels from penetrating trauma requiring immediate damage-control surgery. Methods This retrospective observational multicenter study assessed casualties treated for 8 months by five medical teams deployed in Africa and Middle East. Two experts, who were experienced in military emergency medicine but did not take part in the missions, carried out an independent analysis for each case, evaluating the contribution of US to the following five items: triage categorization, diagnosis, clinical severity, prehospital therapeutic choices, and priority to operation room. Consensus was obtained using the Delphi method with three rounds. Results Of 325 casualties, 189 underwent US examination. The mean injury severity scale score was 25.6, and 76% were wounded by an improvised explosive device. Ultrasound was useful for confirming (23%) or excluding (63%) the suspected diagnosis made in the clinical assessment. It also helped obtain a diagnosis that had not been considered for 3% of casualties and was responsible for a major change in procedure or therapy in 4%. Ultrasound altered the surgical priority in 43% of cases. For 30% of cases, US permitted surgery to be temporarily delayed to prioritize another more urgent casualty. Conclusion Ultrasound is a valuable tool for the management of mass casualties by improving treatment and triage, especially when surgical resources are limited. In some situations, US can also correct a diagnosis or improve prehospital therapeutic choices. Field medical teams should be trained to integrate US into their prehospital protocols. Level of evidence Case series (no criterion standard), level V. |
| Databáze: | OpenAIRE |
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