Echo préhospitalière: Expertise à construire svp!

Prehospital ultrasound of the abdomen and thorax changes trauma patient management: A systematic review

O’Dochartaigh D et Al. Injury, Int. J. Care Injured 46 (2015) 2093–2102

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L'échographie tend à prendre une place de plus en plus importante dans notre quotidien. L'existence d'appareils portables, à l'ergonomie et la performance sans cesse améliorée, procède à la généralisation de cet outil d'évaluation dont on comprend bien l'intérêt. Pour autant qu'apporte réellement ce moyen d'exploration et tout particulièrement en préhospitalier ? Et bien les choses ne sont pas si évidentes que cela. Sauf à être mis en oeuvre par des mains expertes et pour des pathologies ciblées et malgré l'engouement général l'intérêt réel reste à prouver. Ce travail n'est pas isolé (1, 2) et devrait nous pousser à une certaine pondération et surtout à des efforts de formation des praticiens ayant recours à cette technique (3).

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Background: Ultrasound examination of trauma patients is increasingly performed in prehospital services. It is unclear if prehospital sonographic assessments change patient management: providing prehospital diagnosis and treatment, determining choice of destination hospital, or treatment at the receiving hospital.

Objective: This review aims to assess and grade the evidence that specifically examines whether prehospital ultrasound (PHUS) of the thorax and/or abdomen changes management of the trauma patient.

Methods: A systematic review was conducted of trauma patients who had an ultrasound of the thorax or abdomen performed in the prehospital setting. PubMed, MEDLINE, Web of Science (CINAHL, EMBASE, Cochrane Central Register of Controlled Trials) and the reference lists of included studies were searched. Methodological quality was checked and risk of bias analysis performed, a level of evidence grade was assigned, and descriptive data analysis performed.

Results: 992 unique citations were identified, which included eight studies that met inclusion criteria with a total of 925 patients. There are no reports of randomised controlled trials. Heterogeneity exists between the included studies which ranged from a case series to retrospective and prospective nonrandomised observational studies. Three studies achieved a 2+ Scottish Intercollegiate Guidelines Networks grade for quality of evidence and the remainder demonstrated a high risk of bias. The three best studies each provided examples of prehospital ultrasound positively changing patient management.

Conclusion: There is moderate evidence that supports prehospital physician use of ultrasound for trauma patients. For some patients, management was changed based on the results of the PHUS. The benefit of ultrasound use in non-physician services is unclear.