212 3D Volume Ultrasound of the Right Lower Quadrant for Diagnosis of Appendicitis

Abstract

Study Objectives: Emergency point-of-care ultrasound (POCUS) performed by non-physician out-of-hospital providers has shown promise in limited applications but is not widely utilized. No studies have examined the use of critical care ultrasound (US) by non-physician out-of-hospital providers in the out-of-hospital setting. Our objective was to evaluate whether critical care US performed by out-of-hospital providers can clarify the cause of symptoms or change management.Methods: Twenty aeromedical flight nurses completed a didactic and hands-on US curriculum focusing on critical care applications (cardiac, pulmonary, inferior vena cava, Focused Assessment with Sonography in Trauma [FAST]). To assess competency, all providers subsequently passed an objective structured US exam. Portable ultrasound devices (SonoSite iVIZ) were used during patient transports from both scene activations and referring hospitals when deemed clinically indicated by the provider. Post-transport surveys rated provider confidence on a 5-point Likert scale in initial assessment of patient cardiac function, intravascular volume status, cause of hypotension, and cause of respiratory distress when applicable. If US was performed, providers rated if US clarified the cause of symptoms or changed management on a 5-point Likert scale. Associations were evaluated with between-groups t-tests and contingency table analysis.Results: Providers completed 829 surveys over 14 months and reported US use during 102 (12.3%) patient transports. Of the transports in which US was used, ICU to ICU (58.8%) was the most frequent, followed by ED to ED (28.4%), ED to ICU (4.9%) and scene to ED (2.9%). Providers agreed or strongly agreed that US use clarified the cause of patient symptoms in 67.4% and changed management in 36.4% of transports. Transports in which US was used were more likely to involve a critically ill patient (92%) than flights in which US was not used (73%) (p < 0.001). Providers were significantly more likely to use US when less confident in initial assessment of patient cardiac function, intravascular volume status, and cause of respiratory distress (p < 0.05).Conclusions: Non-physician out-of-hospital providers can learn and perform critical care US. Non-physician performed US can clarify the cause of patient symptoms and change management in the out-of-hospital setting.