Department of Emergency Medicine, San Francisco, CA.
Acad Emerg Med. 2013 Sep;20(9):920-5. doi: 10.1111/acem.12206.
Emergency physicians (EPs) frequently evaluate patients at risk for diseases that cause optic disc swelling, and they may encounter conditions that make traditional fundoscopy difficult or impossible. The objective was to assess whether EP-performed point-of-care (POC) ultrasound (US) could accurately assess swelling of the optic disc.
This was a blinded, prospective study using a convenience sample of patients presenting to a neuroophthalmology clinic who were thought to be at risk for conditions associated with optic disc edema. Two EPs performed POC US examinations. Patients then underwent standard clinical assessment by a specialist.
Fourteen patients were assessed with disc swelling noted on dilated fundoscopic exam in 11 of 28 (39%) eyes. A maximum disc height greater than 0.6 mm as measured by US predicted the presence of optic disc edema noted on fundoscopic exam, with a sensitivity of 82% (95% confidence interval [CI] = 48% to 98%) and a specificity of 76% (95% CI = 50% to 93%). A threshold value of 1.0 mm for disc height yielded a sensitivity of 73% (95% CI = 39% to 94%) and a specificity of 100% (95% CI = 81% to 100%). Measurements of disc height as determined by optical coherence tomography (OCT) exhibited good correlation when compared to US measurements (r = 0.836, p < 0.0001, 95% CI = 0.65 to 0.93).
These data suggest that EP-performed POC US can detect clinically apparent optic disc swelling. Because sonography can be performed readily at the bedside, even in cases where fundoscopy is difficult or impossible, this technique may prove to be a valuable tool for the assessment of optic disc swelling in the emergency department (ED).
急诊医师（EP）经常评估患有视神经盘肿胀疾病风险的患者，并且他们可能会遇到使传统眼底镜检查变得困难或不可能的情况。目的是评估 EP 进行即时护理（POC）超声（US）是否可以准确评估视神经盘肿胀。
这是一项使用便利样本的、针对神经眼科诊所就诊的、被认为存在与视神经盘水肿相关疾病风险的患者的、盲法、前瞻性研究。两位 EP 进行了 POC US 检查。然后，患者接受了专科医生的标准临床评估。
在 28 只眼中的 11 只（39%）眼的散瞳眼底镜检查中发现盘状肿胀的 14 例患者接受了评估。通过 US 测量的最大视神经盘高度大于 0.6 mm 预测了在眼底镜检查中观察到的视神经盘水肿的存在，其敏感性为 82%（95%置信区间 [CI] = 48%至 98%），特异性为 76%（95% CI = 50%至 93%）。视神经盘高度阈值为 1.0 mm 时，敏感性为 73%（95% CI = 39%至 94%），特异性为 100%（95% CI = 81%至 100%）。与 US 测量相比，光学相干断层扫描（OCT）测量的视神经盘高度显示出良好的相关性（r = 0.836，p < 0.0001，95% CI = 0.65 至 0.93）。
这些数据表明，EP 进行的 POC US 可以检测到临床明显的视神经盘肿胀。由于超声检查可以在床边轻松进行，即使在眼底镜检查困难或不可能的情况下，该技术也可能成为急诊部门（ED）评估视神经盘肿胀的有价值工具。
