Diagnostics
Usefulness of hand-held ultrasound devices in
out-of-hospital diagnosis performed by
emergency physicians
Fre´de´ric Lapostolle MD
*
, Tomislav Petrovic MD, Gilles Lenoir MD, Jean Catineau MD,
Michel Galinski MD, Jacques Metzger MD, Erick Chanzy MD, Fre´de´ric Adnet MD, PhD
SAMU 93, UPRES 3409, Universite´ Paris XIII, Hoˆpital Avicenne, 93009 Bobigny, France
Accepted 1 July 2005
Abstract
Objective: To evaluate the usefulness of ultrasonographic examinations as a diagnostic tool for
emergency physicians in out-of-hospital settings.
Methods: Prospective study performed in a French teaching hospital.
Eight emergency physicians given ultrasound training for out-of-hospital diagnosis of pleural,
peritoneal, or pericardial effusion; deep venous thrombosis; and arterial flow interruption.
After clinical examination, a probability of diagnosis (bclinical scoreQ) was assigned on visual analog
scale from 0 (absent lesion) to 10 (present lesion). Clinical score between 3 and 7 was considered as
clinically doubtful. After ultrasound examination, a second probability (b ultrasound score Q) was
similarly determined. Potential usefulness of ultrasound examination was evaluated by calculating the
absolute difference between clinical and ultrasound scores. Patients were followed up to determine final
diagnosis: present or absent lesion. bUltrasound usefulness score Q (USS) was determined attributing a
positive (when ultrasonography increased diagnostic accuracy) or a negative (when ultrasonography
decreased diagnostic accuracy) value to the absolute difference between clinical and ultrasound scores.
Results: One hundred sixty-nine patients were included and 302 ultrasound examinations performed.
Median duration of examination was 6 minutes (5-10 minutes). The suspected lesion was found in
45 cases (17%). Mean USS was +2 (0-4). Ultrasonographic examination improved diagnostic accuracy
(ie, positive USS) in 181 (67%) cases, decreased it (ie, negative USS) in 22 (8%) cases, and was not
contributive (ie, USS was 0) in 67 (25%) cases. When initial diagnosis was uncertain (n = 115),
diagnostic performance reached +4 (3-5) and ultrasonographic examination improved diagnostic
accuracy in 103 (90%) cases.
Conclusion: Out-of-hospital ultrasonography increased diagnostic accuracy in out-of-hospital settings.
D 2006 Elsevier Inc. All rights reserved.
0735-6757/$ – see front matter D 2006 Elsevier Inc. All rights reserved.
doi:10.1016/j.ajem.2005.07.010
* Corresponding author. Tel.: +33 1 48 96 44 55; fax: +33 148 96 44 45.
E-mail address: frederic.lapostolle@avc.ap-hop-paris.fr (F. Lapostolle).
American Journal of Emergency Medicine (2006) 24, 237 – 242
www.elsevier.com/locate/ajem