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Table 2 Included studies examining mixed patient populations or ultrasound for procedural guidance

From: The role of point of care ultrasound in prehospital critical care: a systematic review

First author, year n Study type Aim US types, providers Main results Rating
Mixed populations
 Quick, 2016 149 patients Controlled (prehospital paramedics vs in-hospital physicians) To evaluate the ability of ability of in-flight thoracic US to identify pneumothorax (trauma and medical patients) Lung (PTX), paramedics compared to ED physicians Gold standard chest CT (n = 116). Prehospital sensitivity of 68% (95% CI 46–85), specificity 96% (95% CI 90–98), accuracy 91% (95% CI 85–95). Physician-based ED US; sensitivity 84% (95% CI 62–94),
specificity 98% (95% CI 93–99), accuracy 96% (95% CI 90–98).
+
 O’Dochertaigh, 2017 455 missions Cohort To describe the use of US to support interventions when used by physicians and non-physicians (trauma and medical patients) Trauma ultrasound and IVC, highly trained physicians and non-physicians (paramedics) Interventions was supported in US in 26% (95% CI 18–34) of cases when used by non-physicians, and in 45% (95% CI 34–56) when used by physicians (p < 0.006) 0
 Roline, 2013 71 (41 scans) Cohort To evaluate the feasibility of bedside thoracic US (trauma and medical patients) Lung (PTX), prehospital care providers (paramedics?) In 71 eligible patients, 41 (58%) scans were completed. Level of agreement between flight crew and expert substantial with a kappa of 0.67, (95% CI 0.44–0.90). 54% of images were rated “good”. Causes for not completing US were lack of time or space limitation in aircraft. +
 Ketelaars, 2013 281 patients, 326 exams Cohort To evaluate the impact of US chest examinations on the care of patients in a HEMS service (trauma and cardiac arrest patients) Heart, lung (PTX), abdomen, experienced physicians PTX sensitivity 38%, specificity 97%, PPV 90%, NPV 69%.
Treatment plan changed in 60 (21%) patients; in 10 (4%) a chest tube was abandoned; in 10 (4%) the destination for definitive care was changed, in 9 (3%) cardiopulmonary resuscitation was stopped and in 31 (11%) there were other changes.
+
Procedural guidance
 Chenaita, 2012 130 patients Diagnostic accuracy To estimate the diagnostic accuracy of US confirmation of gastric tube placement Abdominal (gastric), experienced physicians Sensitivity 98.3% (95% CI 94–99.5), specificity 100% (95% CI 75.7–100). PPV 100%, NPV 85.7%. Correlation between gastric tube size and visualization (larger tubes easier to see) +
 Brun, 2014 32 Controlled study (2-point US vs syringe test) To estimate the diagnostic accuracy of 2-point US to confirm gastric tube placement Esophageal, abdominal, physicians 100% visualization of gastric tube in the esophagus, 62.5% in the stomach. X-ray confirmed 28/32 in correct position. US higher diagnostic accuracy than syringe test. 0
 Zadel, 2015 124 patients Diagnostic accuracy To assess the sensitivity and specificity of US for confirming endotracheal intubation Lung (lung sliding and diaphragm excursion), certified physicians Gold standard, capnography. US sensitivity 100%, specificity 100%, PPV 100%, NPV 100%.
Median US time 30 s.
0
  1. Abbreviations: US ultrasound, PTX pneumothorax, CI confidence interval, ED emergency department, CT computed tomography, IVC inferior vena cava, PPV positive predictive value, NPV negative predictive value
  2. Rating scale: ++ High quality, + Acceptable, − Low quality/unacceptable, 0 Rejected