Premium
Using non‐mydriatic fundus photography to detect fundus pathology in Australian metropolitan emergency departments: A prospective prevalence and diagnostic accuracy study
Author(s) -
Dunn Hamish P,
Teo Kai Zong,
Smyth James WP,
Weerasinghe Lakni S,
Costello Julia,
Pampapathi Preethi,
Keay Lisa,
Green Tim,
Vukasovic Matthew,
Bruce Beau B,
Newman Nancy J,
Biousse Valérie,
White Andrew J,
McCluskey Peter,
Fraser Clare L
Publication year - 2021
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.13619
Subject(s) - medicine , fundus photography , fundus (uterus) , emergency department , prospective cohort study , ophthalmology , optometry , ophthalmoscopy , confidence interval , medical diagnosis , radiology , pathology , fluorescein angiography , retinal , psychiatry
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.