Impact of Portable Pre-Hospital Ultrasound on Patients’ Outcomes: A Narrative Review

Abstract

1. Introduction
This narrative review aims to survey the available literature on ultrasound (US) use in the pre-hospital environment, together with its potential impact on patients' diagnoses and outcomes, and the challenges pre-hospital care providers are likely to face. Portable, fast, and on-site accurate information, to timely exclude, confirm, or guide the treatment of any medical or traumatic injury during transportation or on the scene, can improve patients' outcomes, reducing healthcare costs. Currently, the pre-hospital environment is known to logistically and technically challenge the execution of US, with high variability in the infrastructure, resources, and capabilities of the various organizations providing emergency medical services. The analysis directly targets the assessment of the impact on patients' outcomes of pre-hospital US. These interventions include diagnostic performance studies, training, educational/teaching programs, and changes in the pre-hospital US setting and the use of images for remote interpretations.
Methods
A literature search was performed in May 2020, aiming to explore the impact of portable pre-hospital ultrasound on patients’ outcomes. The framework guided the literature review process. In particular, this process comprised (i) selecting, (ii) collecting and reading, (iii) analyzing and identifying, (iv) reviewing, organizing, and (v) composing. In the step of selecting, the databases were searched to retrieve articles on pre-hospital portable ultrasound, published up to 2 years before May 2020. The keywords used in the search were (i) pre-hospital, (ii) portable, (iii) ultrasound/point-of-care ultrasound, and (iv) outcome.
Conclusion
We found evidence suggesting that the use of portable pre-hospital ultrasound improves outcomes for certain diseases and injuries. Reduced time to diagnosis in these conditions has been associated with improved patient safety and an overall faster time to treatment. In current systems, pre-hospital diagnostic capabilities are very limited, and the treated versus transported paradigm is common. Perhaps the biggest impact will be in regions that are underserved or where the health system is unable to deliver rapid diagnostic solutions. In systems where other resources are available but not delivered rapidly, only certain groups benefit from the diagnostic and therapeutic options. The use of ultrasounds could provide an improvement in patient outcomes, particularly in specific disease entities, as well as demonstrating to stakeholders the worth of this enhanced care mode. The rapid diagnosis of an intra-abdominal bleed, particularly if other diagnostic modalities are not available, might demonstrate effects that would justify and assist the widespread adoption of pre-hospital portable ultrasound use. Further study into these specific disease entities is warranted.