Emergency Department Use of Ocular Point-of-Care Ultrasound and Its Utility in Diagnosis at a Tertiary Academic Medical Center.

Abstract

To determine whether the use of ocular point-of-care ultrasound (POCUS) impacts emergency department (ED) need for referral to ophthalmology. Retrospective, cross-sectional study. The study included 282 patients who presented at the Vanderbilt University Medical Center (VUMC) ED between January 1, 2021, and October 31, 2024, with an eye-related chief symptom and received both an ocular POCUS and ED or outpatient ophthalmology consultation within 1 week. We collected data from the patient's electronic health record on whether the patient was referred to ophthalmology, the diagnosis made by POCUS, and the diagnosis made by the ophthalmologist. The study's primary outcomes were the percentage of patients referred to an ophthalmologist, the agreement between the diagnosis made by ocular POCUS and the ophthalmologist, and the sensitivity and specificity of POCUS in diagnosing retinal detachment, vitreous hemorrhage, posterior vitreous detachment, and nonvitreoretinal pathology. Secondary outcomes included the positive predictive value (PPV) and negative predictive value (NPV) of POCUS in diagnosing the previously described pathologies. Of the patients who received a POCUS, 91.5% were referred to ophthalmology, including 82.6% of patients with an unremarkable POCUS result. There was moderate agreement between the diagnosis made by POCUS and ophthalmology (k = 0.48, P < 0.01). Point-of-care ultrasound had a high sensitivity for detecting vitreoretinal pathology, such as retinal detachments (sensitivity [sn] = 93.8%, specificity [sp] = 93.8%) and vitreous hemorrhages (sn = 73.0%, sp = 92.8%). However, the sensitivity for detecting nonvitreoretinal pathology was lower (sn = 13.3%, sp = 99.5%). There were several vision-threatening conditions that were not diagnosed by POCUS. Our data show that the results of ocular POCUS had minimal impact on the need for patients to be seen by an ophthalmologist at a tertiary academic center. Furthermore, although POCUS does have a high sensitivity for detecting retinal detachment and vitreous hemorrhage, it has only moderate accuracy and a low sensitivity for detecting other ocular pathologies that may require prompt intervention, most importantly retinal vascular disease and ischemic optic neuropathy, thereby limiting its use as a diagnostic tool. The author(s) have no proprietary or commercial interest in any materials discussed in this article.