The accuracy of prehospital paramedic assessment and treatment of undifferentiated dyspnea with and without point of care ultrasound
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Citation
Abstract
Dyspnea is one of the top reasons for emergency department (ED) visits and hospital admission. Chronic obstructive pulmonary disease and congestive heart failure, are two of the most common causes of dyspnea and often coexist within patients making it difficult to differentiate which disease process is causing the symptomatology. Field paramedics have therapeutics to treat these conditions yet they do not have access to diagnostic imaging for evaluation which is a standard of practice in hospital settings. Point of care ultrasound (POCUS) has become standard practice for emergency physicians offering bedside, real time images that help to diagnose and treat patients. POCUS provides high sensitivity and specificity when differentiating between lung pathologies.
Research indicates that prehospital lung POCUS led by physicians can positively influence evaluation and treatment of patients. Multiple studies have also revealed the feasibility of prehospital paramedic POCUS. However, most prehospital emergency medical services in the United States have not yet invested in POCUS for their paramedic-level providers.
A gap in knowledge has been identified. Research on prehospital paramedic-operated POCUS has yet to explore the use of lung POCUS on stable and unstable patients with a substantial population size. This study aims to assess the accuracy of paramedic interpretation of lung POCUS on prehospital patients with dyspnea and to report changes in accuracy of treatment.
This paper proposes a study that will specifically investigate the accuracy of prehospital lung POCUS performed by paramedics by assessing their ability to differentiate between lung POCUS image findings when compared to ultrasound (US)-fellowship trained emergency physicians. Cohen’s kappa will be computed to evaluate the reliability between the paramedics’ and expert US-fellowship trained physicians’ findings. Secondarily, it will determine if there was a difference in the accuracy of treatment in patients who received lung POCUS prehospital. The secondary aim will be analyzed using a chi-squared test. Lastly, descriptive statistics including frequencies will be demonstrated in percentage, and 95% confidence intervals.
Given that shortness of breath is associated with morbidity and mortality, proper field identification and treatment would likely have a positive impact on many patients nationally. POCUS can also reduce total patient care costs in the ED which is a major cause of financial ruin in the United States. The intention of this paper is to review the current literature involving prehospital paramedic use of POCUS and to propose a study that will assess whether lung POCUS makes a positive impact on paramedic evaluation and treatment in the field.