Carlos M. Romero, MS4
The Article: “Retrospective Review of Ocular Point-of-Care Ultrasound for Detection of Retinal Detachment.”
The Idea: Ocular complaints represent between 2-3% of emergency departments (ED) visits. This includes many vision threatening diagnoses such as retinal detachment, occurring in 3-4% of patients presenting with ocular complaints. Retinal detachment is one of the few ophthalmologic emergencies commonly seen in the ED. It requires immediate assessment, diagnosis and treatment to prevent permanent vision loss. Over the past decade, ophthalmology-specific courses and formal ophthalmology rotations have declined significantly across medical schools within the United States. This puts emergency physicians and the patients they serve in a compromising position to correctly diagnose and/or properly refer their patients. In rural settings, an on-call ophthalmologist may not be available. The use of bedside ocular point-of-care ultrasound (POCUS) has the potential to properly identify ocular emergencies in these settings.
The Study: This study was a retrospective review of charts of ED patients with suspected retinal detachment who underwent POCUS between July 2012-May2015.
Inclusion Criteria: All patients at this institution who were billed for an ocular POCUS between the days of July 2012-May 2015
Exclusion Criteria: No exclusion criteria
Primary Endpoints:
1) Can an emergency medicine physicians and resident reliably diagnose a retinal detachment by means of ocular POCUS in the ED when compared to the diagnosis of the consulting ophthalmologist.
Secondary Endpoints: No secondary endpoint
Results: There were a total of 109 patients enrolled in this study. Of the 34 patients diagnosed with retinal detachment by the ophthalmologists, 31 were correctly identified as having retinal detachment by the EP using ocular POCUS. Of the 75 patients who did not have retinal detachment, 72 were ruled out by ocular POCUS by the EP. This resulted in a POCUS sensitivity of 91% (95% CI [76-98]) and specificity of 96% (95% CI [89-99]).
The Takeaway: This retrospective study suggests that ocular POCUS performed by EPs can aid in the diagnosis of retinal detachment in ED. The study’s endpoint was simply correct diagnosis. To this end, one third of the ocular POCUS were done by one attending physician which may have skewed the data. The ocular POCUS done by emergency physicians were also viewable by ophthalmologist which could also influence their diagnosis. Larger studies are needed with focus on patient outcomes. It has not been shown that diagnosis in the emergency department improves outcomes by more quickly detecting retinal detachments. The level of training necessary to get reliable diagnosis should also be delineated.