Impact of Point-of-Care Ultrasound in Medicalized Prehospital Setting on Diagnostic Workup: A Prospective...

The primary objective of this study was to describe the indications for performing point-of-care ultrasound (POCUS) in prehospital settings. The secondary objective was to assess its impact on the diagnostic workup when its use was initiated by the emergency physician (EP) dispatched with a mobile intensive care unit (MICU).

This prospective observational cohort study was conducted within the MICU of Toulouse University Hospital from December 1, 2022, to May 31, 2023. All adult patients managed by the Toulouse MICU for whom the EP performed a POCUS examination were eligible for inclusion. EP was asked to state the diagnostic hypothesis being evaluated and to rate its likelihood before and after POCUS assessment. The hypothesis and the evaluation of the EP before and after POCUS were compared to the final diagnosis at hospital discharge.

Over the 6-month study period, 83 had a POCUS by a MICU. The indications for performing POCUS were: high-energy trauma (n = 50 [60%]), chest pain (n = 20 [24%]), dyspnea (n = 9 [11%]), abdominal pain (n = 3 [4%]), and cardiac arrest (n = 1 [1%]). The diagnostic impression was more often consistent with the final diagnosis after POCUS than before (58 [70%] vs. 36 [43%]; P < .001). POCUS modified the diagnostic assessment wrongly in 7 (8%) patients and rightly in 28 (34%) patients.

The most frequent indications for prehospital POCUS were high-energy trauma, chest pain, and dyspnea. POCUS improved the rate of initial diagnostic assessments consistent with the final diagnosis.