James Paul Benjamin Sen, Jonathan Emerson, John Franklin
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引用次数: 0
摘要
背景：院前环境中现在可以随时使用超声波，超声波的使用已被列为院前护理研究的重中之重。临床检查仍是院前环境中诊断肺损伤的标准方法，但这可能具有挑战性，而且诊断准确性较低。本综述评估了院前超声诊断创伤患者气胸、血胸和肺挫伤的准确性：方法：进行了系统回顾和荟萃分析。检索了 MEDLINE/PubMed、CINAHL、Embase 和 Cochrane 图书馆。仅纳入了在院前或直升机急救服务环境中，以 CT 或手术结果为参考标准，报道肺部超声对创伤性气胸、血胸或肺挫伤诊断准确性的论文。非英语研究或报告动物研究的文章被排除在外。采用诊断准确性研究质量评估标准（Quality Assessment of Diagnostic Accuracy Studies-2）评估纳入研究的方法学质量：结果：共纳入了六项观察性研究，其中四项研究的偏倚风险较低，两项研究的偏倚风险较高，共报告了 1908 例创伤患者的胸部超声检查结果。对于气胸，荟萃分析得出的汇总灵敏度为 29%（95% CI 22% 至 37%，I2=0%），汇总特异度为 98%（95% CI 97% 至 99%，I2=0%）。对于是否存在血气胸的可靠荟萃分析，报告的数据不足。只有一项研究报告了是否存在肺挫伤，因此没有进行分析：结论：与医院研究相比，院前超声波的特异性很高，但对气胸的敏感性较低。除了对院前医疗人员进行教育和培训外，还需要开展进一步的研究，以进一步探讨造成本综述中观察到的差异的因素：CRD42023365034。
Diagnostic accuracy of prehospital ultrasound in detecting lung injury in patients with trauma: a systematic review and meta-analysis.
Background: Ultrasound is now readily available in the prehospital setting and its use has been highlighted as one of the top research priorities in prehospital care. Clinical examination remains the standard care for diagnosing lung injury in the prehospital setting, yet this can be challenging and has poor diagnostic accuracy. This review evaluates the accuracy of prehospital ultrasound for the diagnoses of pneumothorax, haemothorax and pulmonary contusions in patients with trauma.
Methods: A systematic review and meta-analysis was conducted. MEDLINE/PubMed, CINAHL, Embase and the Cochrane Library were searched. Only papers reporting on the diagnostic accuracy of lung ultrasound for traumatic pneumothorax, haemothorax or pulmonary contusions; in a prehospital or helicopter emergency medical service setting; and with CT or operative findings as a reference standard, were included. Non-English studies or articles that reported on animal studies were excluded. The Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess the methodological quality of the included studies.
Results: Six observational studies, four with low risk of bias and two with some concerns, reporting on 1908 thoracic ultrasound examinations in patients with trauma, were included. For pneumothorax, meta-analysis yielded pooled sensitivity of 29% (95% CI 22% to 37%, I2=0%) and pooled specificity of 98% (95% CI 97% to 99%, I2=0%). Insufficient data were reported for a reliable meta-analysis on the presence of haemothorax. Only one study reported on the presence of pulmonary contusions and therefore no analysis was conducted.
Conclusion: Prehospital ultrasound is highly specific but has a lower sensitivity for the presence of pneumothorax when compared with hospital studies. Further research is required, alongside education and training of prehospital providers, to further explore the factors that account for the differences observed in this review.
期刊介绍：
The Emergency Medicine Journal is a leading international journal reporting developments and advances in emergency medicine and acute care. It has relevance to all specialties involved in the management of emergencies in the hospital and prehospital environment. Each issue contains editorials, reviews, original research, evidence based reviews, letters and more.
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