Acil servise göz travması ile başvuran hastalarda odaklanmış göz ultrasonografisinin tanısal değerliliği
Küçük Resim Yok
Dosyalar
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç Acil servise göz travması ile başvuran hastalarda, hasta başında odaklanmış göz ultrasonografisinin tanısal etkinliğini değerlendirmeyi amaçladık Materyal ve Metot Prospektif ve metodolojik olarak yapılan çalışmamızda 22 Ekim 2020-21 Ekim 2021 tarihleri arasında 18 yaş üstü, göz travması ile acil servise kabul edilen 143 hasta, hedefe yönelik odaklanmış göz ultrasonografisi ile değerlendirilmiştir. Ek olarak göz travması ve maksillofasiyal travmanın birlikte olduğu yetişkin hastalarda odaklanmış göz ultrasonografisi ile OSKÇ ölçümü yaparak, yüksek kafa içi basınç varlığı araştırıldı. Klinik sonlanım ile korelasyonu araştırıldı. Ultrasonografi ile elde edilen veriler çalışma formu aracılığı ile kaydedilmiştir. Elde edilen veriler bilgisayarlı tomografi ve/veya göz hekimi klinik muayenesi ile karşılaştırılmıştır. Bulgular Çalışmamıza toplam 143 hasta dahil edildi. Çalışmamıza dahil olan hastaların büyük çoğunluğunu %83,21(n=119) ile erkekler oluşturdu. Çalışmamızda en fazla hasta sayısını 18-39 yaş grubu oluşturdu. En sık yaralanma mekanizmasını künt yaralanmalar, en sık yaralanma nedenini iş kazaları(%26,57), en sık yaralanma bulgusunu periorbital ekimoz(%36) ve periorbital ödem(%31,1) oluşturdu. Çalışma sonuçlarımız göz hekimi son tanısı ile karşılaştırıldığında lens dislokasyonu için duyarlılık %92,85, özgüllük %98,9, PPD %92,85, NPD %98,9; göz perforasyonu için duyarlılık %80, özgüllük %98,9, PPD %92,3, NPD%96,8; koroid dekolmanı için duyarlılık %100, özgüllük %95,2, PPD %44, NPD %100; retina dekolmanı için duyarlılık %66,6, özgüllük %99, PPD %66,6, NPD %99; göz içi yabancı cisim için duyarlılık %83,3, özgüllük%99, PPD %83,33, NPD %99; vitröz hemoraji için duyarlılık %86,6, özgüllük %95,7, PPD %76,5, NPD %97,8 olarak sonuçlandı. Retrobulber hematom tanısı açısından odaklanmış göz ultrasonografisi, bilgisayarlı tomografi son tanısı ile karşılaştırıldığında USG duyarlılığı %63,6, özgüllüğü %95,87, PPD %63,63, NPD %95,87 olarak bulunmuştur. Tüm göz yaralanmalarında USG’nin PPD ve özgüllük değeri yüksekti. Çalışmamıza katılan hastalardan takipte BT görüntüleme sonrası intrakraniyal kanama saptanan hastalarda USG ile OSKÇ ölçümü değerlendirildiğinde; kafa içi basınç artışı için eşik alt değer 5 mm kabul edildiğinde, kafa içi basınç artışını tanımadaki duyarlılığı yüksek(%100), ancak özgüllük düşük(%15); OSKÇ eşik alt değeri 5,7 mm olarak alındığında duyarlılık %100, özgüllük ise %50 saptandı. Çalışmaya alınan göz yaralanmalı hastaların %79,7’sinde göz hastalıkları birimince acil göz patolojisi düşünülmedi. Çalışmaya alınan göz yaralanmalı hastaların %19,5 unda acil operasyon ve hastane yatış ihtiyacı mevcuttu. Bir hasta ise başka hastaneye sevk edildi. Sonuç Odaklanmış göz ultrasonografisi, acil servise göz yaralanması ile başvuran hastalarda orbital BT’ye ek olarak veya BT görüntüleme yapılamayacak hastalarda, BT’ye alternatif olarak hasta başında uygulanabilen, etkin, tekrarlanabilir, radyasyon içermeyen, dinamik ve kolay ulaşılabilir bir görüntüleme yöntemidir.
Objective We aimed to evaluate the diagnostic accuracy of focused ocular ultrasonography at the bedside in patients admitted to the emergency department with eye trauma. Material and Method In our prospective and methodological study, 143 patients, over the age of 18 who were admitted to the Ege University Hospital Department of Emergency Medicine, with eye trauma between 22 October 2020 and 21 October 2021 were evaluated with ocular point of care ultrasonography(POCUS). In addition, the presence of elevated intracranial pressure was investigated by using focused eye ultrasonographic measurement of optic nerve sheath diameter in adult patients with combined eye trauma and maxillofacial trauma. Correlation with clinical outcome was investigated. The data, obtained by ultrasonography were recorded through the study form. The obtained data were compared with computerized tomography and/or ophthalmologist clinical examination. Results A total of 143 patients were included in our study. Majority of all injuries occured in the men(83,21%, n=119). In our study, the largest number of patients was the 18-39 age group. The most frequent mechanisms were blunt related injuries, the most frequent causes were occupational accidents related injuries(26,57%). The most common injury findings associated with ocular injury were periorbital ecchymosis(36%) and periorbital edema(31,1%). When our study results were compared with the final diagnosis of the ophthalmologist the sensitivity and specificity of point of care focused eye ultrasonography for lens dislocation were 92,85% and 98,9%, positive predictive value and negative predictive value were 92,85% and 98,9%; the sensitivity and specificity of point of care eye ultrasonography for eye perforation were 80% and 98,9%, positive predictive value and negative predictive value were 92,3% and 96,8%. The sensitivity of point of care focused eye ultrasonography for choroidal detachment was 80%, specificity was 95,2%, positive predictive value was 44%, negative predictive value was 100%, the sensitivity of point of care eye ultrasonography for detection of retinal detachment was 66,6%, specificity was 99%, positive predictive value was 66,6%, negative predictive value was 99%, the sensitivity of ultrasonography for detection of intraocular foreign body was 83,3%, specificity was 99%, positive predictive value was 83,3%, negative predictive value 99%. For vitreous hemorrhage sensitivity was 86,6%, specificity was 95,7%, PPV was 76,5%, NPV was 97,8% compared with the ophthalmologist clinical examination. For the diagnosis of retrobulbar hematoma, when the final diagnosis of focused eye ultrasonography compared with the computed tomography, the sensitivity of USG was 63,6%, specificity was 95,87, PPV was 63,63%, NPV was 95,87%. PPV and specificity were high in all eye injuries. Brain CT imaging was performed on eighty eight of the patients with signs of maxillofacial injury who had participated in our study, after the decision of the emergency department physician. Ultrasonographic optic nerve sheath measurement was performed in patients with intracranial hemorrhage after the CT imaging. When the cutoff value was accepted as 5mm, the sensitivity of detecting elevated intracranial pressure was high(100%), but the specificity was low(15%); when the cutoff value was accepted as 5,7mm, the sensitivity was found 100% and the specificity was found 50% for detecting elevated intracranial pressure. Emergency eye pathology was not considered by the ophthalmology unit in 79,7% of the patients included in the study. 19,5% of the patients with eye injury included in the study needed emergency operation and hospitalization. One patient was transferred to another hospital. Conclusion Focused eye ultrasonography is an effective, reproducible, radiation free, dynamic and easily accessible imaging method that can be applied at the bedside in addition to orbital CT in patients presenting to the emergency department with eye injuries. And also focused eye ultrasonography is an alternative method to CT in patients who can not have CT imaging.
Objective We aimed to evaluate the diagnostic accuracy of focused ocular ultrasonography at the bedside in patients admitted to the emergency department with eye trauma. Material and Method In our prospective and methodological study, 143 patients, over the age of 18 who were admitted to the Ege University Hospital Department of Emergency Medicine, with eye trauma between 22 October 2020 and 21 October 2021 were evaluated with ocular point of care ultrasonography(POCUS). In addition, the presence of elevated intracranial pressure was investigated by using focused eye ultrasonographic measurement of optic nerve sheath diameter in adult patients with combined eye trauma and maxillofacial trauma. Correlation with clinical outcome was investigated. The data, obtained by ultrasonography were recorded through the study form. The obtained data were compared with computerized tomography and/or ophthalmologist clinical examination. Results A total of 143 patients were included in our study. Majority of all injuries occured in the men(83,21%, n=119). In our study, the largest number of patients was the 18-39 age group. The most frequent mechanisms were blunt related injuries, the most frequent causes were occupational accidents related injuries(26,57%). The most common injury findings associated with ocular injury were periorbital ecchymosis(36%) and periorbital edema(31,1%). When our study results were compared with the final diagnosis of the ophthalmologist the sensitivity and specificity of point of care focused eye ultrasonography for lens dislocation were 92,85% and 98,9%, positive predictive value and negative predictive value were 92,85% and 98,9%; the sensitivity and specificity of point of care eye ultrasonography for eye perforation were 80% and 98,9%, positive predictive value and negative predictive value were 92,3% and 96,8%. The sensitivity of point of care focused eye ultrasonography for choroidal detachment was 80%, specificity was 95,2%, positive predictive value was 44%, negative predictive value was 100%, the sensitivity of point of care eye ultrasonography for detection of retinal detachment was 66,6%, specificity was 99%, positive predictive value was 66,6%, negative predictive value was 99%, the sensitivity of ultrasonography for detection of intraocular foreign body was 83,3%, specificity was 99%, positive predictive value was 83,3%, negative predictive value 99%. For vitreous hemorrhage sensitivity was 86,6%, specificity was 95,7%, PPV was 76,5%, NPV was 97,8% compared with the ophthalmologist clinical examination. For the diagnosis of retrobulbar hematoma, when the final diagnosis of focused eye ultrasonography compared with the computed tomography, the sensitivity of USG was 63,6%, specificity was 95,87, PPV was 63,63%, NPV was 95,87%. PPV and specificity were high in all eye injuries. Brain CT imaging was performed on eighty eight of the patients with signs of maxillofacial injury who had participated in our study, after the decision of the emergency department physician. Ultrasonographic optic nerve sheath measurement was performed in patients with intracranial hemorrhage after the CT imaging. When the cutoff value was accepted as 5mm, the sensitivity of detecting elevated intracranial pressure was high(100%), but the specificity was low(15%); when the cutoff value was accepted as 5,7mm, the sensitivity was found 100% and the specificity was found 50% for detecting elevated intracranial pressure. Emergency eye pathology was not considered by the ophthalmology unit in 79,7% of the patients included in the study. 19,5% of the patients with eye injury included in the study needed emergency operation and hospitalization. One patient was transferred to another hospital. Conclusion Focused eye ultrasonography is an effective, reproducible, radiation free, dynamic and easily accessible imaging method that can be applied at the bedside in addition to orbital CT in patients presenting to the emergency department with eye injuries. And also focused eye ultrasonography is an alternative method to CT in patients who can not have CT imaging.
Açıklama
Anahtar Kelimeler
Bakım Noktası Göz Ultrasonu, Acil Servis, Travmatik Göz Yaralanmaları, Yatak Başı Oküler Ultrason, Bakım Noktası Ultrasonografisi, Point-of-Care Ocular Ultrasound, Emergency Department, Traumatic Eye Injuries, Bedside Ocular Ultrasound, Point of Care Ultrasonography
