Hamish P Dunn1,2,3, Kai Zong Teo1,2, James Wp Smyth1,4, Lakni S Weerasinghe1,2,3, Julia Costello5, Preethi Pampapathi2, Lisa Keay6, Tim Green1,4, Matthew Vukasovic5, Beau B Bruce7,8,9, Nancy J Newman7,8,10, Valérie Biousse7,8, Andrew J White1,2,6, Peter McCluskey11,12, Clare L Fraser1,12. 1. Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia. 2. Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia. 3. Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia. 4. Department of Emergency Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. 5. Department of Emergency Medicine, Westmead Hospital, Sydney, New South Wales, Australia. 6. School of Optometry and Vision Science and The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia. 7. Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA. 8. Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA. 9. Department of Epidemiology, Emory University School of Medicine, Atlanta, Georgia, USA. 10. Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA. 11. Department of Ophthalmology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. 12. Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Abstract
OBJECTIVE: To determine the prevalence of fundus pathology in metropolitan Australian EDs utilising a non-mydriatic fundus photography screening programme. Secondary objectives include diagnostic accuracy among emergency physicians compared to telehealth ophthalmologist review. METHODS: Prospective cross-sectional study investigating non-mydriatic fundus photography as a new diagnostic test in two tertiary Australian EDs. Consecutive adult patients were enrolled if they presented with headache, focal neurological deficit, visual disturbance or diastolic BP >120 mmHg. Diagnostic agreement was determined using kappa statistics and sensitivity and specificity using a reference standard consensus ophthalmology review. RESULTS: A total of 345 consecutive patients were enrolled among whom 56 (16%, 95% confidence interval [CI] 13-21) had urgent fundus pathology. Agreement between emergency physician and ophthalmic assessment of fundus photographs was 74% (kappa = 0.196, P = 0.001). Emergency physicians had 40% sensitivity (95% CI 27-54) and 82% specificity (95% CI 76-86) for detecting urgent pathology on photographs. CONCLUSIONS: Fundus photography detects a clinically significant proportion of fundus pathology and urgent diagnoses. Telehealth specialist image review is important to detect some important, time-critical illnesses that can be missed in routine care. This offers an accurate alternative to direct ophthalmoscopy that warrants further research in Australian EDs.
OBJECTIVE: To determine the prevalence of fundus pathology in metropolitan Australian EDs utilising a non-mydriatic fundus photography screening programme. Secondary objectives include diagnostic accuracy among emergency physicians compared to telehealth ophthalmologist review. METHODS: Prospective cross-sectional study investigating non-mydriatic fundus photography as a new diagnostic test in two tertiary Australian EDs. Consecutive adult patients were enrolled if they presented with headache, focal neurological deficit, visual disturbance or diastolic BP >120 mmHg. Diagnostic agreement was determined using kappa statistics and sensitivity and specificity using a reference standard consensus ophthalmology review. RESULTS: A total of 345 consecutive patients were enrolled among whom 56 (16%, 95% confidence interval [CI] 13-21) had urgent fundus pathology. Agreement between emergency physician and ophthalmic assessment of fundus photographs was 74% (kappa = 0.196, P = 0.001). Emergency physicians had 40% sensitivity (95% CI 27-54) and 82% specificity (95% CI 76-86) for detecting urgent pathology on photographs. CONCLUSIONS: Fundus photography detects a clinically significant proportion of fundus pathology and urgent diagnoses. Telehealth specialist image review is important to detect some important, time-critical illnesses that can be missed in routine care. This offers an accurate alternative to direct ophthalmoscopy that warrants further research in Australian EDs.
Authors: George He; Hamish P Dunn; Kate E Ahmad; Eloise Watson; Andrew Henderson; Dominique Tynan; John Leaney; Andrew J White; Alex W Hewitt; Clare L Fraser Journal: Eur J Neurol Date: 2022-05-31 Impact factor: 6.288