title: The diagnostic accuracy of bedside ocular ultrasonography for the diagnosis of retinal detachment: a systematic review and meta-analysis.
abstract: The diagnostic accuracy of emergency department (ED) ocular ultrasonography may be sufficient for diagnosing retinal detachment. We systematically reviewed the literature to determine the diagnostic accuracy of ED ocular ultrasonography for the diagnosis of retinal detachment. This review conformed to the recommendations from the Meta-analysis of Observational Studies in Epidemiology statement. An experienced medical librarian searched the following databases from their inception, without language restrictions: Ovid MEDLINE, PubMed, EMBASE, the Cochrane Library, Emergency Medical Abstracts, and Google Scholar. Content experts were contacted and bibliographies of relevant studies were reviewed to identify additional references. Evidence quality was independently assessed by 2 investigators using the revised Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). Discrepancies were resolved by consensus or adjudication by a third reviewer. Diagnostic test characteristics were summarized and reported with 95% confidence intervals. Of 7,771 unique citations identified, 78 were selected for full-text review, resulting in 4 trials assessed for quality. Agreement between authors' QUADAS-2 scoring was good (κ=0.63). Three trials were deemed to have a low risk of bias. They enrolled ED-based patients (N=201) and evaluated clinician-performed bedside ocular ultrasonography, using either a 7.5- or 10-MHz linear-array probe. Two trials included patients who had retinal detachment from trauma. The prevalence of retinal detachment ranged from 15% to 38%. Sensitivity and specificity ranged from 97% to 100% and 83% to 100%, respectively. The results of the bedside ocular ultrasonography were compared with the reference standard of an ophthalmologic evaluation; one trial also included orbital computed tomography findings suggestive of retinal detachment. Bedside ocular ultrasonography has a high degree of accuracy in identifying retinal detachment, according to 3 small prospective investigations. Larger prospective validation of these findings would be valuable.
authors.affiliation: Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN. Electronic address: mevrablik@gmail.com.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Vrablik
authors.affiliation: Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Snead
authors.affiliation: Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Hal J
authors.initials: HJ
authors.lastname: Minnigan
authors.affiliation: Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Kirschner
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Emmett
authors.affiliation: Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
authors.forename: Rawle A
authors.initials: RA
authors.lastname: Seupaul
mesh_terms: D005123:Eye / Q000000981:diagnostic imaging*; D006801:Humans; D019095:Point-of-Care Systems; D012015:Reference Standards; D012163:Retinal Detachment / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014463:Ultrasonography