scholarly journals Test Characteristics of Point‐of‐care Ultrasound for the Diagnosis of Retinal Detachment in the Emergency Department

2018 ◽  
Author(s):  
Daniel J. Kim ◽  
Mario Francispragasam ◽  
Gavin Docherty ◽  
Byron Silver ◽  
Ross Prager ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retinal Detachment ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Test Characteristics

scholarly journals P047: Test characteristics of point of care ultrasound for the diagnosis of retinal detachment in the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S93-S94
Author(s):  
G. Docherty ◽  
M. Francispragasam ◽  
B. Silver ◽  
R. Prager ◽  
D. Maberley ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retinal Detachment ◽  
Likelihood Ratio ◽  
Sensitivity And Specificity ◽  
Point Of Care ◽  
Small Sample ◽  
Heterogeneous Group ◽  
Point Of Care Ultrasound ◽  
Convenience Sample ◽  
Test Characteristics

Introduction: The acute onset of flashes and floaters is a common presentation to the emergency department (ED). The most emergent etiology is retinal detachment (RD), which requires prompt ophthalmologic assessment. Previous studies of point of care ultrasound (POCUS) have reported high sensitivity and specificity for RD, but are limited by small sample size, use of highly trained and experienced sonographers, and referral bias. Our primary objective was to assess the test characteristics of POCUS performed by a large heterogeneous group of emergency physicians (EPs) for the diagnosis of RD. Methods: This was a prospective diagnostic test assessment of POCUS performed by EPs with varying ultrasound experience on a convenience sample of ED patients presenting with the complaint of flashes or floaters in one or both eyes. Participating EPs completed a one hour didactic lecture and were expected to demonstrate appropriate performance of one practice scan before enrolling patients. After standard ED assessment, patients underwent an ocular POCUS scan targeted to detect RD. EPs recorded the presence or absence of RD on the data collection instrument based on their POCUS scan. After completing their ED visit, all patients were assessed by a retina specialist who was blinded to the results of the POCUS scan. We calculated sensitivity and specificity with associated exact binomial confidence intervals (CI) using the retina specialist’s determination of the final diagnosis as the criterion standard. Results: A total of 30 EPs, consisting of 21 staff physicians and 9 residents, participated in this study. These EPs performed a total of 128 POCUS scans. Of these scans, 13 were excluded. Of the remaining 115 enrolled patients, median age was 60 years, and 64% were female. The retina specialist diagnosed RD in 16 (14%) cases. The sensitivity and specificity of POCUS for detecting RD was 75% (95% CI 48% to 93%) and 94% (95% CI 87% to 98%), respectively. The positive likelihood ratio was 12.4 (95% CI 5.4 to 28.3), and negative likelihood ratio was 0.27 (95% CI 0.11 to 0.62). Conclusion: In a heterogeneous group of EPs with varying ultrasound experience, POCUS demonstrates high specificity but only intermediate sensitivity for the detection of RD. A negative POCUS scan is not sufficiently sensitive to rule out RD in a patient with new onset flashes or floaters.

scholarly journals Uveal Melanoma Identified as Ocular Mass on Point-of-care Ultrasound

2021 ◽  
Vol 5 (3) ◽  
pp. 367-368
Author(s):  
Hannah Spungen ◽  
Daniel Weingrow
Keyword(s):  
Emergency Department ◽  
Retinal Detachment ◽  
Uveal Melanoma ◽  
Vision Loss ◽  
Point Of Care ◽  
Black Spot ◽  
Distant Metastases ◽  
Posterior Chamber ◽  
Point Of Care Ultrasound ◽  
Point Of Care Ultrasonography

Case Presentation: A 41-year-old man presented to the emergency department with five months of progressive monocular vision loss in his right eye, which he described as a gradually descending and enlarging black spot. He had no light perception in his right eye with elevated intraocular pressure and an afferent pupillary defect, while his left eye visual acuity and pupillary exam was normal. Point-of-care ultrasound demonstrated a hyperechoic, pedunculated mass in the posterior chamber of his right eye, consistent with a diagnosis of ocular melanoma. Ophthalmology scheduled the patient for an elective, right eye enucleation the following week, after which a diagnosis of uveal melanoma (UM) was confirmed on histopathology. Discussion: Uveal melanoma is an uncommon diagnosis that requires prompt intervention and surveillance due to the possibility of distant metastases arising in up to 50% of patients. Emergency department diagnosis of UM may be confounded by features of other intraocular pathology, such as increased ocular pressure or the finding of retinal detachment on fundoscopy. When emergency providers encounter glaucoma or retinal detachment on physical exam, point-of-care ultrasonography represents a key adjunct in the timely diagnosis and referral of this potentially vision- and life-threatening malignancy.

scholarly journals Role Of Point Of Care Ultrasound In The Diagnosis Of Retinal Detachment In The Emergency Department

2019 ◽  
Vol Volume 11 ◽  
pp. 265-270
Author(s):  
Shadi Lahham ◽  
Qumber Ali ◽  
Bea Martina Palileo ◽  
Clifton Lee ◽  
John C Fox
Keyword(s):  
Emergency Department ◽  
Retinal Detachment ◽  
Point Of Care ◽  
Point Of Care Ultrasound

Case Report: When all claims that it is necrotizing fasciitis but Point of care ultrasound (POCUS) proves the opposite!

POCUS Journal ◽  
2018 ◽  
Vol 3 (1) ◽  
pp. 13-14
Author(s):  
Hadiel Kaiyasah, MD, MRCS (Glasgow), ABHS-GS ◽  
Maryam Al Ali, MBBS
Keyword(s):  
Emergency Department ◽  
Critical Care ◽  
Case Report ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Soft Tissue Infection ◽  
Critical Care Unit ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Soft Tissue Infections

Soft tissue ultrasound (ST-USS) has been shown to be of utmost importance in assessing patients with soft tissue infections in the emergency department or critical care unit. It aids in guiding the management of soft tissue infection based on the sonographic findings.

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