Retinal Emergencies: Ultrasonography in the ER
By Jean Shaw
Selected By: Deepak P. Edward, MD
JAMA Network Open
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.