Marchese Ronald F, Mistry Rakesh D, Binenbaum Gil, Liu Grant T, Scarfone Richard J, Woodford Ashley L, Chen Aaron E
Emergency Medicine, Children's Hospital Colorado, Aurora, CO.
Ophthalmology and.
Pediatr Emerg Care. 2018 Aug;34(8):531-536. doi: 10.1097/PEC.0000000000001046.
The aim of this study was to determine the feasibility and accuracy of point-of-care (POC) ocular ultrasound (US) when performed by a pediatric emergency medicine (PEM) physician to detect optic nerve abnormalities concerning for swelling, as compared with the fundus examination performed by an ophthalmologist.
This was a single-center, prospective cohort pilot study of children aged 12 months to 18 years who required optic disc evaluation by an ophthalmologist. Eligible subjects were enrolled from the emergency department, inpatient wards, and neuro-ophthalmology outpatient clinic of an urban, tertiary care children's hospital. Point-of-care ocular US, specifically assessing optic nerve sheath diameter and optic disc elevation, was performed. Findings on US were compared with findings identified by an ophthalmologist on dilated fundus examination.
Seventy-six subjects were enrolled; 20 (26%) of 76 had findings concerning for optic nerve swelling diagnosed by an ophthalmologist on fundus examination. Using a sonographic definition for optic nerve swelling of optic nerve sheath diameter greater than 4.5 mm or the presence of optic disc elevation, the sensitivity and specificity were 90% and 55%, respectively. The success rate of POC ocular US was 100%, and the mean time to completion was 8 minutes. For emergency department subjects in whom direct fundus examination was attempted, the PEM physician could visualize the optic disc and assess for swelling in only 40% (14/35) of examinations.
The results of our study suggest that POC ocular US performed by PEM physicians was feasible and determined to be sensitive but nonspecific in the detection of optic nerve swelling. Additional larger studies may determine generalizability to other nonophthalmologist physicians performing POC ocular US.
本研究旨在确定儿科急诊医学（PEM）医生进行的即时护理（POC）眼部超声（US）检测视神经肿胀相关异常的可行性和准确性，并与眼科医生进行的眼底检查相比较。
这是一项针对12个月至18岁需要眼科医生对视盘进行评估的儿童的单中心前瞻性队列试点研究。符合条件的受试者从一家城市三级儿童医院的急诊科、住院病房和神经眼科门诊招募。进行了即时护理眼部超声检查，特别评估视神经鞘直径和视盘抬高情况。将超声检查结果与眼科医生在散瞳眼底检查中发现的结果进行比较。
共招募了76名受试者；76名中的20名（26%）经眼科医生眼底检查诊断为视神经肿胀相关异常。采用视神经鞘直径大于4.5mm或存在视盘抬高作为视神经肿胀的超声定义，敏感性和特异性分别为90%和55%。即时护理眼部超声的成功率为100%，平均完成时间为8分钟。对于尝试进行直接眼底检查的急诊科受试者，PEM医生在仅40%（14/35）的检查中能够可视化视盘并评估肿胀情况。
我们的研究结果表明，PEM医生进行的即时护理眼部超声在检测视神经肿胀方面是可行的，且被确定为敏感但非特异性。更多更大规模的研究可能会确定其对其他进行即时护理眼部超声的非眼科医生的可推广性。
