• Retinal Emergencies: Ultrasonography in the ER

    By Jean Shaw
    Selected By: Deepak P. Edward, MD

    Journal Highlights

    JAMA Network Open
    2019;2(4):e192162

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    Lahham et al. set out to determine whether ocular point-of-care ultraso­nography (POCUS) could be effectively used to screen ER patients for retinal detachment, vitreous hemorrhage, and vitreous detachment. They found that emergency medicine practitioners can use POCUS to accurately detect these three conditions, thus allowing ER staff to confer needed information to the ophthalmologist.

    This prospective study was conduct­ed at four ERs in Southern California (two academic and two county hospital locations). All four sites support an emergency medicine residency, oph­thalmology residency, and emergency ultrasonography fellowship.

    The researchers enrolled 225 patients age 18 years and older who presented to the ER with symptoms suggestive of retinal detachment (RD), vitreous hemorrhage (VH), or vitreous detach­ment (VD).

    Chief concerns included blurry vision, flashers and floaters, and vision loss. Patients who had ocular trauma or a suspected globe rupture were exclud­ed from the study.

    A total of 75 ER personnel (20 emergency medicine attendings, 50 emergency medicine residents, and five supervised physician assistants) evalu­ated the patients with POCUS. This was performed before the patients’ ophthal­mic consultations, and the ophthalmol­ogists who examined the patients were masked as to the POCUS results.

    All told, as diagnosed by an ophthal­mologist, 47 of the patients (20.8%) had an RD, 54 (24%) had a VH, and 34 (15.1%) had a VD. The ER staff correctly identified RDs in 46 of the 47 patients, for a sensitivity of 96.9%. With regard to VH, they identified 46 of the 54 cases, for a sensitivity of 81.9%. Finally, the ER practitioners identified 19 of the 34 cases of VDs, for a sensitivity of 42.5%. Specificity results were as follows: 88.1% for RD, 82.3% for VH, and 96% for VD. These results suggest that POCUS may be an effective adjunct technol­ogy in the ER, helping ER staff detect ophthalmic emergencies and provide needed information to ophthalmol­ogists. In particular, the researchers noted, POCUS may be of particular benefit to ERs in areas where around-the-clock ophthalmologic consultation is not available.

    The original article can be found here.