Presentation Title

Diagnosis of Retinal Detachment in the Emergency Department Using Point-of-Care Ultrasound

Faculty Mentor

Shadi Lahham, Chris Fox

Start Date

18-11-2017 2:15 PM

End Date

18-11-2017 2:30 PM

Location

9-273

Session

Bio Sciences 3

Type of Presentation

Oral Talk

Subject Area

health_nutrition_clinical_science

Abstract

Out of all the patient visits that present to Emergency Departments (EDs), 2-3% include patients diagnosed with certain ocular pathologies such as retinal detachment. Because retinal detachment is considered to be a vision-threatening Ophthalmologic emergency, its early detection and treatment is crucial. Visualization of the eye via point-of-care ultrasound may prove to be effective in identifying the presence of retinal detachment and other ocular pathologies at an earlier stage in a patient’s visit. The primary goal of the study was to determine the utility of Point-of-Care Ultrasound (POCUS) for the diagnosis of retinal detachment in patients presenting to the Emergency Department with ocular complaints. We organized a prospective observational study for ED patients greater than 18 years of age with suspected retinal detachment. Any potential patients who were unable to speak English, arrived with critical traumas, and or incarcerated were excluded from enrollments. Emergency Medicine attending physicians, fellows, and resident physicians performed POCUS for eye complaints in which retinal detachment was included in the differential diagnosis. The diagnosis was compared to the criterion gold standard of an ophthalmologist consultation - including a fundoscopic exam - and corresponding diagnosis. The sensitivity and specificity were calculated for POCUS with 95% confidence intervals, along with the positive and negative predictive values.A total of 94 patients were enrolled in the study. We found the incidence of retinal detachment to be 19.1%. POCUS demonstrated an overall sensitivity of 100% [95% CI, 81.4%-100%], specificity of 86.8% [77.1%-93.5%], PPV of 64%, and NPV of 100% in the ED. In conclusion, ocular POCUS performed by Emergency Medicine physicians demonstrates a high sensitivity and specificity in detecting the presence or absence of retinal detachment.

Summary of research results to be presented

We enrolled 94 patients for this study, of which 18 were diagnosed with retinal detachment by an ophthalmologist, an incidence of 19.1%. Point-of-care ocular ultrasound exhibited a sensitivity of 100% for these patients with a 95% confidence interval of 81.4% to 100%. The specificity of these ultrasounds was 86.8% with a 95% confidence interval of 77.1% to 93.5%. Lastly, the positive predictive value for the correct diagnosis of retinal detachment using ultrasound was calculated at 64%, while the negative predictive value was 100%.

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Nov 18th, 2:15 PM Nov 18th, 2:30 PM

Diagnosis of Retinal Detachment in the Emergency Department Using Point-of-Care Ultrasound

9-273

Out of all the patient visits that present to Emergency Departments (EDs), 2-3% include patients diagnosed with certain ocular pathologies such as retinal detachment. Because retinal detachment is considered to be a vision-threatening Ophthalmologic emergency, its early detection and treatment is crucial. Visualization of the eye via point-of-care ultrasound may prove to be effective in identifying the presence of retinal detachment and other ocular pathologies at an earlier stage in a patient’s visit. The primary goal of the study was to determine the utility of Point-of-Care Ultrasound (POCUS) for the diagnosis of retinal detachment in patients presenting to the Emergency Department with ocular complaints. We organized a prospective observational study for ED patients greater than 18 years of age with suspected retinal detachment. Any potential patients who were unable to speak English, arrived with critical traumas, and or incarcerated were excluded from enrollments. Emergency Medicine attending physicians, fellows, and resident physicians performed POCUS for eye complaints in which retinal detachment was included in the differential diagnosis. The diagnosis was compared to the criterion gold standard of an ophthalmologist consultation - including a fundoscopic exam - and corresponding diagnosis. The sensitivity and specificity were calculated for POCUS with 95% confidence intervals, along with the positive and negative predictive values.A total of 94 patients were enrolled in the study. We found the incidence of retinal detachment to be 19.1%. POCUS demonstrated an overall sensitivity of 100% [95% CI, 81.4%-100%], specificity of 86.8% [77.1%-93.5%], PPV of 64%, and NPV of 100% in the ED. In conclusion, ocular POCUS performed by Emergency Medicine physicians demonstrates a high sensitivity and specificity in detecting the presence or absence of retinal detachment.