Use of ocular ultrasound for the evaluation of retinal detachment.
BACKGROUND
Retinal detachment is an ocular emergency posing diagnostic difficulty for the emergency practitioner. Direct fundoscopy and visual field testing are difficult to perform and do not completely rule out retinal detachment. Ophthalmologists use ocular ultrasound to enhance their clinical acumen in detecting retinal detachments (RD), and bedside ultrasound capability is readily available to many emergency practitioners (EP).


OBJECTIVE
Our study sought to assess whether ocular ultrasound would be a helpful adjunct for the diagnosis of RD for the practicing EP.


METHODS
This was a prospective observational study with a convenience sample of patients. As part of a general course on emergency ultrasonography, practitioners received a 30-min training session on ocular ultrasound before beginning the study. Trained practitioners submitted ultrasound scans with interpretation on patients with signs and symptoms consistent with retinal detachment.


RESULTS
Thirty-one of the 72 practitioners trained submitted ocular ultrasound reports on patients presenting to the Emergency Department with concerns for retinal detachments. EPs achieved a 97% sensitivity (95% confidence interval [CI] 82-100%) and 92% specificity (95% CI 82-97%) on 92 examinations (29 retinal detachments). Disc edema and vitreous hemorrhage accounted for false positives, and a subacute retinal detachment accounted for the only false negative.


CONCLUSIONS
These data show that trained emergency practitioners can use ocular ultrasound as an adjunct to their clinical assessment for retinal detachment.
Shinar
Zachary
Z
Department of Emergency Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
Chan
Linda
L
Orlinsky
Michael
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D004487:Edema / Q000000981:diagnostic imaging; D004502:Education, Medical, Continuing; D004635:Emergency Medicine / Q000592:standards*; D005123:Eye / Q000000981:diagnostic imaging*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012163:Retinal Detachment / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014465:Ultrasonics / Q000193:education; D014463:Ultrasonography; D014822:Vitreous Body; D014823:Vitreous Hemorrhage / Q000000981:diagnostic imaging