Robotic Optical Coherence Tomography Retinal Imaging for Emergency Department Patients: A Pilot Study for Emergency Physicians’ Diagnostic Performance - 20/03/23
Abstract |
Study objective |
To evaluate the diagnostic performance of emergency physicians’ interpretation of robotically acquired retinal optical coherence tomography images for detecting posterior eye abnormalities in patients seen in the emergency department (ED).
Methods |
Adult patients presenting to Duke University Hospital emergency department from November 2020 through October 2021 with acute visual changes, headache, or focal neurologic deficit(s) who received an ophthalmology consultation were enrolled in this pilot study. Emergency physicians provided standard clinical care, including direct ophthalmoscopy, at their discretion. Retinal optical coherence tomography images of these patients were obtained with a robotic, semi-autonomous optical coherence tomography system. We compared the detection of abnormalities in optical coherence tomography images by emergency physicians with a reference standard, a combination of ophthalmology consultation diagnosis and retina specialist optical coherence tomography review.
Results |
Nine emergency physicians reviewed the optical coherence tomography images of 72 eyes from 38 patients. Based on the reference standard, 33 (46%) eyes were normal, 16 (22%) had at least 1 urgent/emergency abnormality, and the remaining 23 (32%) had at least 1 nonurgent abnormality. Emergency physicians' optical coherence tomography interpretation had 69% (95% confidence interval [CI], 49% to 89%) sensitivity for any abnormality, 100% (95% CI, 79% to 100%) sensitivity for urgent/emergency abnormalities, 48% (95% CI, 28% to 68%) sensitivity for nonurgent abnormalities, and 64% (95% CI, 44% to 84%) overall specificity. In contrast, emergency physicians providing standard clinical care did not detect any abnormality with direct ophthalmoscopy.
Conclusion |
Robotic, semi-autonomous optical coherence tomography enabled ocular imaging of emergency department patients with a broad range of posterior eye abnormalities. In addition, emergency provider optical coherence tomography interpretation was more sensitive than direct ophthalmoscopy for any abnormalities, urgent/emergency abnormalities, and nonurgent abnormalities in this pilot study with a small sample of patients and emergency physicians.
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| Please see page 502 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Robert D. Welch, MD, MS. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: AS, MD, PO, RPM, and ANK were responsible for study conception and design. AS, KR, and JBL performed data collection. RT undertook recruitment of participating emergency physicians. AS, KR, JBL, NGV, and EML analyzed the data. AS wrote the first draft of the manuscript. AS, JBL, NGV, PO, RT, ATL, JAI, RPM, and ANK contributed substantially to its revision. AS and ANK takes responsibility for the paper as a whole. |
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| Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This study was supported by NIH/NEI (R01-EY029302). AS received research support from NIH-NCATS (TL1-TR002555) and Research to Prevent Blindness Medical Student Eye Research Fellowship. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. RPM and ANK receive unrelated grant support from Johnson and Johnson Vision (issued to the institution). RPM, JAI, and ANK receive royalties from Leica Microsystems. ATL has had funded research contracts with Roche Diagnostics, Inc, Abbott Laboratories, Hospital Quality Foundation, Bristol Meyers Squibb, Ischemia Care, Ltd, GE, AstraZeneca, Forest Devices, Inc, Regeneron, Becton Dickinson, SENSE Neuro Diagnostics, and Ophirex, Inc. All of the above are work unrelated to this study. MD, PO, JAI, RPM, and ANK have a pending patent application for the robotically aligned optical coherence tomography system. |
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| Publication dates: Received for publication July 4, 2022. Revisions received September 11, 2022; October 5, 2022. Accepted for publication October 11, 2022. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 81 - N° 4
P. 501-508 - avril 2023 Regresar al número
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