Remote Diagnosis of Retinal Detachment in an Emergency Department Using Nonmydriatic Hybrid Ocular Imaging.

IF 2.8 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Telemedicine and e-Health Pub Date : 2025-02-01 Epub Date: 2024-09-30 DOI:10.1089/tmj.2024.0435
Nithya Shanmugam, Etienne Benard-Seguin, Sruthi Arepalli, George Alencastro, Jessica G McHenry, Mariana Rodriguez Duran, Mariam Torres Soto, Andrew M Pendley, David W Wright, Nancy J Newman, Valérie Biousse
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Abstract

Background: Ocular emergencies are commonly evaluated in general emergency departments (ED) where ophthalmologists are rarely available. Nonmydriatic ocular imaging combining color fundus photographs and optical coherence tomography (NMFP-OCT) can help with rapid remote triage by ophthalmologists. We evaluated the rate at which retinal detachments (RDs) can be diagnosed with NMFP-OCT in the ED. Methods: Quality improvement project with prospective collection of data on RD patients who had NMFP-OCT obtained by ED staff over 1 year. Photographs were interpreted remotely by ophthalmologists and all patients underwent an in-person ophthalmologic examination in the ED to confirm the presence of a RD. Results: A total of 63 eyes (58 patients) had a RD, among which 53 (84.1%) had strong suggestion of RD on ocular imaging (34 [54%] were seen on both color and OCT nerve/macula; 11 [17.5%] were seen on color but missed on OCT; 8 [12.7%] were missed on color but seen on OCT). Ten RDs (15.9%) were missed on both color and OCT because of peripheral location of the RD (4, 40%), vitreous hemorrhage (4, 40%), or poor image quality (2, 20%). A total of 40 out of 58 patients were not seen by an eye care provider prior to reaching our ED and 10 had an inappropriate stroke workup for acute vision loss of presumed vascular origin. Conclusion: NMFP-OCT of the posterior pole obtained by ED staff revealed the RD in 84.1% of eyes, allowing for rapid remote triage of patients with visual symptoms and avoiding unnecessary testing when the diagnosis of RD is confirmed.

急诊科使用非眼动力混合眼成像远程诊断视网膜脱离
背景:眼部急症通常在普通急诊科(ED)进行评估,而急诊科很少有眼科医生。结合彩色眼底照片和光学相干断层扫描(NMFP-OCT)的非眼动力眼部成像有助于眼科医生进行快速远程分诊。我们评估了在急诊室使用 NMFP-OCT 诊断视网膜脱离 (RD) 的比率。方法:开展质量改进项目,前瞻性地收集急诊室工作人员在一年内使用 NMFP-OCT 诊断视网膜脱离患者的数据。照片由眼科医生进行远程解读,所有患者均在急诊室接受了现场眼科检查,以确认是否存在 RD。结果:共有 63 只眼睛(58 名患者)出现了 RD,其中 53 只(84.1%)在眼部成像上有强烈的 RD 暗示(34 只 [54%] 在彩色成像和 OCT 神经/虹膜成像上均可见;11 只 [17.5%] 在彩色成像上可见,但在 OCT 上未见;8 只 [12.7%] 在彩色成像上未见,但在 OCT 上可见)。有 10 个 RD(15.9%)在彩色和 OCT 上均漏诊,原因是 RD 位于外周(4 个,占 40%)、玻璃体出血(4 个,占 40%)或图像质量差(2 个,占 20%)。在 58 名患者中,共有 40 名患者在到达急诊室之前没有接受过眼科医疗服务,10 名患者因推测为血管性急性视力下降而接受了不适当的卒中检查。结论急诊室工作人员获得的后极点 NMFP-OCT 检查显示,84.1% 的眼睛存在 RD,可对有视力症状的患者进行快速远程分流,并在确诊 RD 后避免不必要的检查。
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来源期刊
Telemedicine and e-Health
Telemedicine and e-Health 医学-卫生保健
CiteScore
8.80
自引率
6.40%
发文量
270
审稿时长
2.3 months
期刊介绍: Telemedicine and e-Health is the leading peer-reviewed journal for cutting-edge telemedicine applications for achieving optimal patient care and outcomes. It places special emphasis on the impact of telemedicine on the quality, cost effectiveness, and access to healthcare. Telemedicine applications play an increasingly important role in health care. They offer indispensable tools for home healthcare, remote patient monitoring, and disease management, not only for rural health and battlefield care, but also for nursing home, assisted living facilities, and maritime and aviation settings. Telemedicine and e-Health offers timely coverage of the advances in technology that offer practitioners, medical centers, and hospitals new and innovative options for managing patient care, electronic records, and medical billing.
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