Official Proceedings - AIUM

American Institute of Ultrasound in Medicine Proceedings J Ultrasound Med 32(suppl):S1–S134, 2013SCIENTIFIC SESSIONSWEDNESDAY, APRIL 10, 2013, 10:45 AM–12:30 PMEmergency Ultrasound, Part 2Moderator: Leslie Scoutt, MD1540052 A Systematic Review of the Diagnostic Accuracy of BedsideOcular Ultrasound in the Diagnosis of Retinal DetachmentJonathan Kirschner,* Hal Minnigan, Michael Vrablik,Gregory Snead, Rawle Seupaul Emergency Medicine, IndianaUniversity School of Medicine, Indianapolis, Indiana USAObjectives—Systematically review the literature to determinethe diagnostic accuracy of bedside ocular ultrasound (OUS) in the diagnosisof retinal detachment.Methods—The design of this review conformed to the recommendationsfrom the Meta-analysis of Observational Studies in Epidemiologystatement. An experienced medical librarian searched the followingdatabases from their inception without language restrictions: Ovid MED-LINE, PubMed, EMBASE, the full Cochrane Library, Emergency MedicalAbstracts, and Google Scholar. Content experts were contacted, andbibliographies of relevant studies were reviewed to identify additional references.Studies were included if they prospectively recruited adult patientswith acute signs and symptoms suggestive of retinal detachmentand provided enough detail on diagnostic test and criterion standard resultsto construct contingency tables. Evidence quality was independently assessedby 2 investigators using the revised Quality Assessment Tool for DiagnosticAccuracy Studies (QUADAS-2). Discrepancies were resolvedby consensus or adjudication by a third reviewer. Diagnostic test characteristicswere summarized for trials with a low risk of bias.Results—Of 7771 unique citations identified, 78 were selectedfor full text review, resulting in 4 trials assessed for quality. Agreementbetween authors’ QUADAS-2 scoring was good (κ = 0.63). Overall trialquality was deemed to be excellent with a low risk of bias in 3 studies. All3 trials enrolled emergency department–based patients (N = 199) and evaluatedclinician-performed bedside OUS using either a 7.5- or 10-MHz lineararray probe. The prevalence of retinal detachment ranged from 13%to 38%. Sensitivity and specificity ranged from 97% to 100% and 83% to100%, respectively.Conclusions—Bedside OUS has a high degree of accuracy inidentifying retinal detachment based on 3 small prospective investigations.A larger prospective validation of these findings would be valuable.1540708 Accuracy and Interobserver Agreement of Point-of-CareUltrasound for Diagnosis of Skull Fractures in ChildrenJoni Rabiner, 1 * Jeffrey Avner, 1 Hnin Khine, 1 Lana Friedman, 2James Tsung 2 1 Pediatrics, Division of Emergency Medicine,Children’s Hospital at Montefiore/Albert Einstein College ofMedicine, Bronx, New York USA; 2 Emergency Medicine, Divisionof Pediatric Emergency Medicine, Mount Sinai School ofMedicine/Mount Sinai Medical Center, New York, New YorkUSAObjectives—To determine the test performance characteristicsand interobserver agreement for point-of-care ultrasound (US) performedby clinicians compared to computed tomography (CT) or x-ray diagnosisof skull fractures.Methods—This was a prospective study of a convenience sampleof patients 6 mm, appendix wall thickness >2 mm, periappendiceal fluid, andsonographic McBurney’s sign (univariate analysis, P < .05). BUS successand accuracy were independent of operator, parenteral narcotic orantiemetic administration, subject body mass index, or scanning time.Conclusions—BUS was highly sensitive for appendicitis diagnosisin the ED in our study. The presence of several findings in the history,physical exam, and laboratory testing and on BUS increased thelikelihood of the diagnosis.S77