Shinar Zachary, Chan Linda, Orlinsky Michael
Department of Emergency Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
J Emerg Med. 2011 Jan;40(1):53-7. doi: 10.1016/j.jemermed.2009.06.001. Epub 2009 Jul 21.
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).
Our study sought to assess whether ocular ultrasound would be a helpful adjunct for the diagnosis of RD for the practicing EP.
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.
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.
These data show that trained emergency practitioners can use ocular ultrasound as an adjunct to their clinical assessment for retinal detachment.
视网膜脱离是一种眼部急症，给急诊医生带来诊断难题。直接检眼镜检查和视野测试操作困难，且不能完全排除视网膜脱离。眼科医生使用眼部超声来提高其检测视网膜脱离（RD）的临床敏锐度，许多急诊医生（EP）也可随时使用床边超声设备。
我们的研究旨在评估眼部超声对执业急诊医生诊断RD是否有辅助作用。
这是一项采用便利抽样患者的前瞻性观察研究。作为急诊超声常规课程的一部分，医生在开始研究前接受了30分钟的眼部超声培训。经过培训的医生对有视网膜脱离体征和症状的患者进行超声扫描并给出解读报告。
72名接受培训的医生中有31名提交了关于急诊科疑似视网膜脱离患者的眼部超声报告。急诊医生在92次检查（29例视网膜脱离）中，灵敏度达到97%（95%置信区间[CI]82 - 100%），特异度达到92%（95%CI 82 - 97%）。视盘水肿和玻璃体出血导致假阳性，唯一的假阴性是由亚急性视网膜脱离造成的。
这些数据表明，经过培训的急诊医生可以将眼部超声作为其视网膜脱离临床评估的辅助手段。
