Spotlight on Research

Failure to identify pneumothoraces in prehospital care carries the potential for significant consequences due to the potential for worsening of the pneumothorax during transfer. Clinical assessment alone is of limited value in the diagnosis of pneumothoraces, so many may go undetected. The use of ultrasound to increase the sensitivity of pneumothorax detection has become established within the hospital environment and may have utility in the prehospital environment. This study sought to establish the feasibility of non-physicians to undertake prehospital ultrasound pneumothorax diagnosis in a live clinical environment, and assess the accuracy of the diagnosis.

Bilateral lung ultrasound images were randomly selected from 87 patients and assessed using point-of-care ultrasound (POCUS) by three advanced retrieval practitioners (ARPs). Two expert reviewers evaluated these images to determine the quality of the diagnostic images and accuracy of diagnosis.

In total, 22 of the 24 images were considered adequate by the ARPs, but only 19 were considered adequate on expert review. Of those 19 images, both the ARPs and reviewers identified two pneumothoraces which were subsequently confirmed on chest x-ray. In this study, ARPs were able to obtain adequate images and correctly diagnose pneumothorax in the prehospital environment with 66.6% sensitivity (95%CI 66.6–100%) and 100% specificity (95% CI 81.0–100%) compared to expert review.