Retinal vs vitreous detachment or hemorrhage: yes, they can be distinguished in the ED

  • Lahham S & al.
  • JAMA Netw Open
  • 5 abr. 2019

  • de Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Retinal vs vitreous detachment or hemorrhage can be distinguished using point-of-care ultrasonography (POCUS) in the emergency department (ED).
  • The authors emphasize that the results do not suggest replacement for ophthalmology specialist exam but could be an adjunct in the ED to improve care.

Why this matters

  • Up to 3% of ED visits involve ocular symptoms, and in many cases, without rapid effective treatment, irreversible vision loss is a risk.
  • Editorial calls study well-done with high-quality evidence of the accuracy of POCUS in the ED for these conditions.

Key results

  • For retinal detachment, POCUS had (95% CIs):
    • Sensitivity: 96.9% (80.6%-99.6%); and
    • Specificity: 88.1% (81.8%-92.4%).
  • For vitreous hemorrhage, POCUS had:
    • Sensitivity: 81.9% (63.0%-92.4%); and
    • Specificity: 82.3% (75.4%-87.5%).
  • For vitreous detachment, POCUS had:
    • Sensitivity: 42.5% (24.7%-62.4%); and
    • Specificity: 96.0% (91.2%-98.2%).

Study design

  • Prospective study, 225 patients presenting to 2 academic and 2 county hospital EDs, February 3, 2016 to April 30, 2018.
  • Accuracy of POCUS conclusion compared with final ophthalmologist diagnosis.
  • Funding: None disclosed.

Limitations

  • Unclear how results would translate to other settings.
  • POCUS utility relies on operator experience.