Diagnostic performance and patient outcomes of ultrasound use in trauma triage by Emergency Medical Services teams

Abstract

Background:
Rapid, accurate trauma triage is essential for improving patient outcomes in prehospital emergency care. Ultrasound use by Emergency Medical Services (EMS) teams may enhance early injury detection and guide critical prehospital decisions. This systematic review synthesizes evidence on diagnostic accuracy and patient outcomes associated with prehospital ultrasound (POCUS) in trauma triage.
Methods:
A comprehensive literature search till 2024 was conducted in PubMed, Scopus, and CENTRAL databases following PRISMA guidelines. Ten studies, including five prospective clinical trials and five observational cohorts, met the eligibility criteria. Diagnostic performance (sensitivity, specificity, predictive values), mortality, and other patient-centered outcomes were extracted and narratively synthesized.
Results:
Ultimately, 10 studies fully matched the inclusion criteria and were included in this review. Ultrasound sensitivity for detecting free intra-abdominal fluid ranged from 78% (95% CI: 72–84%) to 92% (95% CI: 88–95%), while specificity consistently exceeded 95% (95–99%). For pneumothorax detection, sensitivity was between 65% (95% CI: 58–72%) and 85% (95% CI: 79–90%), with specificities ranging from 94% to 98%. POCUS influenced triage decisions, reduced mean time to surgery by 25 minutes (95% CI: 15–35 minutes), but showed inconsistent effects on overall 30-day mortality (RR: 0.92, 95% CI: 0.78–1.09).
Conclusions:
Prehospital ultrasound demonstrated high diagnostic specificity and positively influenced triage decisions, though sensitivity varied. Further standardized protocols and training are required.