Background: One of the most emergent ocular complaints is retinal detachment (RD), a condition requiring prompt ophthalmologic assessment. Fortunately, point of care ultrasound (POCUS) holds promise for evaluating acute ocular complaints and is considered scope of practice for emergency physicians (EPs). Previous studies of POCUS for RD reported different conclusions, but were limited by small sample sizes and suffered from referral bias.
Objective: The purpose of this systematic review and meta-analysis is to evaluate all available literature to determine if ocular POCUS performed by EPs is as accurate in diagnosing retinal detachment as ophthalmologist evaluation.
Methods: Search strategy and methods were based on the PRISMA checklist. With the assistance of a medical librarian, search terms were generated for ultrasound and retinal detachment and tailored to each database. The following databases were searched from their inception until November 2018: PubMed, EMBASE, Web of Science database, Cochrane database, CINAHL database, and Clinical Trials.gov. Studies were included if they were prospective and evaluated EP-performed ocular POCUS with subsequent ophthalmologist evaluation as a reference standard. Evidence quality was independently assessed by two investigators using the revised Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). Inter-rater agreement was assessed with Cohen’s Kappa test.
Results: The search identified 5620 unique citations, of which six studies were deemed to have a low risk of bias. All the included studies enrolled ED-based patients (N = 517) and evaluated clinician-performed POCUS using a high frequency linear-array probe. Quantitative analyses revealed that the total pooled sensitivity was 93% (95% CI: 85 -97%) and pooled specificity was 88 % (95% CI: 85-91%). It also showed a pooled positive likelihood ratio of 7.83 (95% CI: 3.97-15.44) and a pooled negative likelihood ratio of 0.121 (95% CI: 0.054-0.27).
Conclusion: This meta-analysis maintains that EP-performed ocular POCUS has a high sensitivity and specificity for diagnosing RD. Data are limited by the quality and size of the original studies. Larger clinical trials are needed to validate these findings.