Diagnosis of Traumatic Eye Injuries With Point-of-Care Ocular Ultrasonography in the Emergency Department - 23/08/19
Abstract |
Study objective |
Traumatic eye injuries are common emergency department presentations worldwide, and diagnosis may be delayed because of concurrent injuries and lack of guidelines in regard to the utility of clinical examination, computed tomography (CT), and point-of-care ultrasonography. In this study, we compare point-of-care ultrasonography with ophthalmologist clinical examination and CT for 6 types of traumatic eye injury.
Methods |
We conducted a prospective cohort study evaluating patients with suspected traumatic eye injury who were recruited at an academic medical center in Tabriz, Iran. Each patient was evaluated by an emergency physician with point-of-care ultrasonography using a 7- to 15-MHz linear transducer, by a radiologist with orbital CT imaging, and by an ophthalmologist with a complete bedside ocular examination. Obtained results were tabulated. Sensitivity, specificity, and likelihood ratios were subsequently calculated. Cohen’s κ was assessed to evaluate the agreement between ocular point-of-care ultrasonography with orbital CT and point-of-care ultrasonography with complete bedside ocular examination.
Results |
Two hundred thirty-two patients (351 eyes) with suspected traumatic eye injury were included. In all measures of accuracy, diagnosis by point-of-care ultrasonography compared favorably with CT and a complete bedside ocular examination by an ophthalmologist in the 6 ocular injury patterns included in this study. Compared with CT imaging, point-of-care ultrasonography provided a specificity of 99.4% (95% confidence interval [CI] 97.8% to 99.9%) and a sensitivity of 96.8% (95% CI 83.3% to 99.9%) in the diagnosis of lens dislocation, and a specificity of 99.7% (95% CI 98.3% to 100.0%) and sensitivity of 95.7% (95% CI 78.1% to 99.9%) in the diagnosis of retrobulbar hematoma. Compared with complete bedside ocular examination by an ophthalmologist, point-of-care ultrasonography provided a specificity of 98.7% (95% CI 96.7% to 99.6%) and sensitivity of 97.8% (95% CI 88.2% to 99.9%) in the diagnosis of vitreous hemorrhage. In all injury types, positive likelihood ratios were high and negative ones were low.
Conclusion |
Point-of-care ultrasonography demonstrates high sensitivity and specificity in the diagnosis of traumatic eye injury, and represents a valuable diagnostic tool in addition to orbital CT and complete beside ocular examination by an ophthalmologist in the diagnosis of traumatic eye injury.
Le texte complet de cet article est disponible en PDF.Plan
| Please see page 366 for the Editor’s Capsule Summary of this article. |
|
| Supervising editor: Frank Scheuermeyer, MD, MHSc. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
|
| Author contributions: SOH conceived the study, designed the trial, and obtained institutional review board approval. SOH and SSV supervised the conduct of the trial and data collection. SOH and SSV undertook recruitment of participating centers and patients and managed the data, including quality control. RS was the ophthalmologist consultant on the study, AP, KML, and SD provided statistical advice on study design and analyzed the data. SOH, AP, KML, SD drafted the manuscript, and all authors contributed substantially to its revision. SOH takes responsibility for the paper as a whole. |
|
| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
|
| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. |
|
| Trial registration number: 92/3-6/5 |
|
| Readers: click on the link to go directly to a survey in which you can provide P85WZ6X to Annals on this particular article. |
Vol 74 - N° 3
P. 365-371 - septembre 2019 Retour au numéro
Article précédent
- Another Look at the Persistent Moral Problem of Emergency Department Crowding
- John C. Moskop, Joel M. Geiderman, Kenneth D. Marshall, Jolion McGreevy, Arthur R. Derse, Kelly Bookman, Norine McGrath, Kenneth V. Iserson
- Effect of Initial Bedside Ultrasonography on Emergency Department Skin and Soft Tissue Infection Management
- William R. Mower, Jonathan G. Crisp, Anusha Krishnadasan, Gregory J. Moran, Fredrick M. Abrahamian, Frank Lovecchio, David J. Karras, Mark T. Steele, Richard E. Rothman, David A. Talan
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?