Results of ultrasonic examination of patients with internal bleeding and multiple injury at the prehospital stage: a literature review

Abstract

Purpose: review and systematisation of publications in scientific medical literature devoted to ultrasound examination of trauma patients at the prehospital stage. Materials and methods: a search in scientific databases SCOPUS, Cochrane, PubMed, Russian Science Citation Index (RSCI) by key words: polytrauma, haemorrhage, evacuation of victims, ultrasound examination (US) was carried out. We analysed 46 literature sources — 2 domestic and 44 foreign, including data of meta ‑ analyses and systematic reviews; 23 studied articles were published in the last 5 years. Results: according to a number of scientific studies, ultrasound examination can be successfully used in patients with polytrauma at the prehospital stage, including during air ambulance evacuation on board a helicopter. Ultrasound examination according to the FAST protocol reduces the time to surgical intervention by 64–76%, reduces the need for radiation exposure, the incidence of complications after injury and the duration of the patient’s hospital stay. According to some authors, the sensitivity, specificity, positive and negative predictive value of the method in detecting intra–abdominal injuries and haemorrhage are 28–76%, 83–97%, 87–96% and 37–94%, respectively, which makes it an important tool for examination of an urgent patient, especially with unstable haemodynamics, influencing the treatment tactics. For the paediatric population in the diagnosis of haemoperitoneum, according to a meta‑analysis, the specificity of US leaves 95%, sensitivity — 66%. The method can be successfully applied in the work of aeromedical teams on board an air ambulance helicopter: according to a systematic review and meta‑analysis, the overall sensitivity of ultrasound in the diagnosis of pneumothorax during air ambulance evacuation is 61%, specificity — 99%. Conclusion: considering the analysed data from large randomised trials, meta‑analyses and systematic reviews, the use of ultrasound allows to make the right decisions regarding the tactics of treatment of the urgent patient, its transportation and choice of hospital, reduces the number of examinations, shortens the time to get the patient to the operating room and the duration of hospital stay, positively affects the outcome of the disease.