Wilson Casey L, Leaman Samuel Madden, O'Brien Clay, Savage Daniel, Hart Leslie, Jehle Dietrich
Grand Strand Medical Center Myrtle Beach South Carolina USA.
University of South Carolina School of Medicine Columbia South Carolina USA.
J Am Coll Emerg Physicians Open. 2021 Jan 4;2(1):e12355. doi: 10.1002/emp2.12355. eCollection 2021 Feb.
The purpose of this study is to determine the sensitivity and specificity of novice emergency physician-performed point-of-care ultrasound diagnosis of papilledema using optic nerve sheath diameter (ONSD) against ophthalmologist-performed dilated fundoscopy. This observational study retrospectively analyzed results of ultrasound-measured ONSD of emergency department (ED) patients with suspected intracranial hypertension from a period spanning June 2014 to October 2017.
This study concerns a population of ED patients at a large, tertiary-care urban academic medical center from June 2014 to October 2017 over the age of 18 years with primary vision complaints evaluated for papilledema both by an emergency physician-performed ultrasound and an ophthalmologist-performed fundoscopic examination during their ED stay. Sensitivity and specificity of emergency physician-performed ultrasound measurement of optic nerve sheath diameter in the diagnosis of papilledema were primary outcomes for this study.
A total of 206 individual patients (male 49%, female 51%; median age 45 years) were included in the study with a total of 212 patient encounters. Calculated sensitivity for the ocular ultrasound examination performed by emergency physicians to diagnose papilledema was 46.9% (95% confidence interval [CI], 32.5% to 61.7%), and specificity was 87.0% (95% CI, 82.8% to 90.5%). Positive predictive value and negative predictive value were calculated to be 35.4% (95% CI, 23.9% to 48.2%) and 91.5% (95% CI, 87.8% to 94.4%), respectively.
Sonographic measurement of ONSD by emergency physicians has low sensitivity but high specificity for detection of papilledema compared to ophthalmologist-conducted fundoscopy.
本研究旨在确定新手急诊医师使用视神经鞘直径（ONSD）进行即时超声诊断视乳头水肿相对于眼科医师进行的散瞳眼底镜检查的敏感性和特异性。这项观察性研究回顾性分析了2014年6月至2017年10月期间急诊科疑似颅内高压患者的超声测量ONSD结果。
本研究涉及2014年6月至2017年10月期间，在一家大型城市三级学术医疗中心急诊科就诊的18岁以上患者，这些患者因主要视力问题在急诊科就诊期间接受了急诊医师进行的超声检查和眼科医师进行的眼底镜检查以评估视乳头水肿。急诊医师进行超声测量视神经鞘直径诊断视乳头水肿的敏感性和特异性是本研究的主要结果。
共有206例个体患者（男性49%，女性51%；中位年龄45岁）纳入研究，共进行了212次患者会诊。急诊医师进行眼部超声检查诊断视乳头水肿的计算敏感性为46.9%（95%置信区间[CI]，32.5%至61.7%），特异性为87.0%（95%CI，82.8%至90.5%）。阳性预测值和阴性预测值分别计算为35.4%（95%CI，23.9%至48.2%）和91.5%（95%CI，87.8%至94.4%）。
与眼科医师进行的眼底镜检查相比，急诊医师通过超声测量ONSD检测视乳头水肿的敏感性较低，但特异性较高。
