Quality of prehospital thoracic ultrasound performed by paramedics

Abstract

<b>Background:</b> In a prehospital setting, the initial evaluation, diagnosing, and management of patients with respiratory symptoms can be challenging. Thoracic ultrasound (TUS) can contribute with important information and support clinical decision-making. However, ultrasound is user dependent. The aim was to explore the quality of thoracic ultrasound examinations performed by paramedics in a prehospital setting. <b>Methods:</b> From November 2018–April 2020 paramedics (n=100) performed TUS on patients using a portable ultrasound device. Patients were included if they had made an emergency call due to respiratory symptoms and were assessed by the paramedic to be in a condition that did not require urgent transport. The TUS examinations were retrospectively rated by a blinded reviewer (image quality score 1-5). The findings and change in treatment or management of the patient was correlated with the reviewers using overall agreement in percentage and as Cohen’s kappa. <b>Results:</b> The ultrasound examinations (n=590) were assessed, resulting in a median image quality score of 3 (IQ1=4, IQ3=3). The overall agreement was high (87.7% for a normal scan, 89.9% for interstitial syndrome, 97.3% for possible pneumothorax, 96.3% for pleural effusion). Cohen’s kappa varied from 0.01 (possible pneumothorax) to 0.69 (pleural effusion). The examination entailed a change in treatment or visitation in 48 cases (11.7%) which encompasses a number-needed-to-scan =8.5. <b>Conclusion:</b> Paramedics perform TUS with adequate image quality to determine if pathology is present or not. The paramedics’ assessment correlates to some extent with an experienced reviewer and their findings are most reliable for a normal scan or inclusion of pleural effusion