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Novice emergency physician ultrasonography of optic nerve sheath diameter compared to ophthalmologist fundoscopic evaluation for papilledema

OBJECTIVES: 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 retr...

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Autores principales: Wilson, Casey L., Leaman, Samuel Madden, O'Brien, Clay, Savage, Daniel, Hart, Leslie, Jehle, Dietrich
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823090/
https://www.ncbi.nlm.nih.gov/pubmed/33532756
http://dx.doi.org/10.1002/emp2.12355
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author Wilson, Casey L.
Leaman, Samuel Madden
O'Brien, Clay
Savage, Daniel
Hart, Leslie
Jehle, Dietrich
author_facet Wilson, Casey L.
Leaman, Samuel Madden
O'Brien, Clay
Savage, Daniel
Hart, Leslie
Jehle, Dietrich
author_sort Wilson, Casey L.
collection PubMed
description OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: Sonographic measurement of ONSD by emergency physicians has low sensitivity but high specificity for detection of papilledema compared to ophthalmologist‐conducted fundoscopy.
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spelling pubmed-78230902021-02-01 Novice emergency physician ultrasonography of optic nerve sheath diameter compared to ophthalmologist fundoscopic evaluation for papilledema Wilson, Casey L. Leaman, Samuel Madden O'Brien, Clay Savage, Daniel Hart, Leslie Jehle, Dietrich J Am Coll Emerg Physicians Open Imaging OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: Sonographic measurement of ONSD by emergency physicians has low sensitivity but high specificity for detection of papilledema compared to ophthalmologist‐conducted fundoscopy. John Wiley and Sons Inc. 2021-01-04 /pmc/articles/PMC7823090/ /pubmed/33532756 http://dx.doi.org/10.1002/emp2.12355 Text en © 2021 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Imaging
Wilson, Casey L.
Leaman, Samuel Madden
O'Brien, Clay
Savage, Daniel
Hart, Leslie
Jehle, Dietrich
Novice emergency physician ultrasonography of optic nerve sheath diameter compared to ophthalmologist fundoscopic evaluation for papilledema
title Novice emergency physician ultrasonography of optic nerve sheath diameter compared to ophthalmologist fundoscopic evaluation for papilledema
title_full Novice emergency physician ultrasonography of optic nerve sheath diameter compared to ophthalmologist fundoscopic evaluation for papilledema
title_fullStr Novice emergency physician ultrasonography of optic nerve sheath diameter compared to ophthalmologist fundoscopic evaluation for papilledema
title_full_unstemmed Novice emergency physician ultrasonography of optic nerve sheath diameter compared to ophthalmologist fundoscopic evaluation for papilledema
title_short Novice emergency physician ultrasonography of optic nerve sheath diameter compared to ophthalmologist fundoscopic evaluation for papilledema
title_sort novice emergency physician ultrasonography of optic nerve sheath diameter compared to ophthalmologist fundoscopic evaluation for papilledema
topic Imaging
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823090/
https://www.ncbi.nlm.nih.gov/pubmed/33532756
http://dx.doi.org/10.1002/emp2.12355
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