TY - JOUR
T1 - Accuracy of Computed Tomography Imaging Criteria in the Diagnosis of Adult Open Globe Injuries by Neuroradiology and Ophthalmology
AU - Crowell, Eric L.
AU - Koduri, Vivek A.
AU - Supsupin, Emilio P.
AU - Klinglesmith, Robert E.
AU - Chuang, Alice Z.
AU - Kim, Gene
AU - Baker, Laura A.
AU - Feldman, Robert M.
AU - Blieden, Lauren S.
N1 - Funding Information:
From the Ruiz Department of Ophthalmology and Visual Science (ELC, VAK, AZC, GK, RMF, LSB) and the Department of Diagnostic and Interventional Imaging (EPS), McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX; the Robert Cizik Eye Clinic (ELC, GK, LAB, RMF, LSB), Houston, TX; the Memorial Hermann–Texas Medical Center (ELC, EPS, GK, RMF, LSB), Houston, TX; and Singleton Associates, PA (REK), Houston, TX. Received March 24, 2017; revision received June 6, 2017; accepted June 25, 2017. This study was supported in part by the National Institutes of Health/National Eye Institute Vision Core Grant P30EY010608, a Challenge Grant from Research to Prevent Blindness to the McGovern Medical School, and the Hermann Eye Fund. ELC, VAK, AZC, GK, RMF, and LSB report grant money from NEI Vision Core Grant P30EY010608, Research to Prevent Blindness, and the Hermann Eye Fund for investigator-initiated research to the Ruiz Department of Ophthalmology and Visual Science. LAB reports grant money from the Hermann Eye Fund for investigator-initiated research to the Robert Cizik Eye Clinic. EPS and REK have disclosed no conflicts of interest. Supervising Editor: Timothy B. Jang, MD. Address for correspondence and reprints: Lauren S. Blieden, MD; e-mail: lblieden@gmail.com ACADEMIC EMERGENCY MEDICINE 2017;24:1072–1079.
Publisher Copyright:
© 2017 by the Society for Academic Emergency Medicine
PY - 2017/9
Y1 - 2017/9
N2 - Objective: The objective was to evaluate the sensitivity and specificity of computed tomography (CT) diagnosis of open globes, determine which imaging factors are most predictive of open globe injuries, and evaluate the agreement between neuroradiologist and ophthalmologist readers for diagnosis of open and closed globes. Methods: This study was a retrospective cohort study. Patients who presented to Memorial Hermann–Texas Medical Center with suspicion for open globes were reviewed. One neuroradiologist and two ophthalmologists masked to clinical information reviewed CT images for signs concerning for open globe including change in globe contour, anterior chamber deformation, intraocular air, vitreous hemorrhage, subretinal fluid indicating retinal or choroidal detachment, dislocated or absent lens, intraocular foreign body, and orbital fracture. Using the clinically or surgically confirmed globe status as the true globe status, sensitivity, specificity, and agreement (kappa) were calculated and used to investigate which imaging factors are most predictive of open globe injuries. Results: A total of 114 patients were included: 35 patients with open globes and 79 patients with closed globes. Specificity was greater than 97% for each reader, and sensitivity ranged from 51% to 77% among readers. The imaging characteristics most consistently used to predict an open globe injury were change in globe contour and vitreous hemorrhage (sensitivity = 43% to 57%, specificity > 98%). The agreement of impression of open globe between the neuroradiologist and ophthalmologists was good and excellent between ophthalmologists. Conclusions: Computed tomography imaging is not absolute, and the sensitivity is still inadequate to be fully relied upon. The CT imaging findings most predictive of an open globe injury were change in globe contour and vitreous hemorrhage. Clinical examination or surgical exploration remains the most important component in evaluating for a suspected open globe, with CT imaging as an adjunct.
AB - Objective: The objective was to evaluate the sensitivity and specificity of computed tomography (CT) diagnosis of open globes, determine which imaging factors are most predictive of open globe injuries, and evaluate the agreement between neuroradiologist and ophthalmologist readers for diagnosis of open and closed globes. Methods: This study was a retrospective cohort study. Patients who presented to Memorial Hermann–Texas Medical Center with suspicion for open globes were reviewed. One neuroradiologist and two ophthalmologists masked to clinical information reviewed CT images for signs concerning for open globe including change in globe contour, anterior chamber deformation, intraocular air, vitreous hemorrhage, subretinal fluid indicating retinal or choroidal detachment, dislocated or absent lens, intraocular foreign body, and orbital fracture. Using the clinically or surgically confirmed globe status as the true globe status, sensitivity, specificity, and agreement (kappa) were calculated and used to investigate which imaging factors are most predictive of open globe injuries. Results: A total of 114 patients were included: 35 patients with open globes and 79 patients with closed globes. Specificity was greater than 97% for each reader, and sensitivity ranged from 51% to 77% among readers. The imaging characteristics most consistently used to predict an open globe injury were change in globe contour and vitreous hemorrhage (sensitivity = 43% to 57%, specificity > 98%). The agreement of impression of open globe between the neuroradiologist and ophthalmologists was good and excellent between ophthalmologists. Conclusions: Computed tomography imaging is not absolute, and the sensitivity is still inadequate to be fully relied upon. The CT imaging findings most predictive of an open globe injury were change in globe contour and vitreous hemorrhage. Clinical examination or surgical exploration remains the most important component in evaluating for a suspected open globe, with CT imaging as an adjunct.
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U2 - 10.1111/acem.13249
DO - 10.1111/acem.13249
M3 - Article
C2 - 28662312
AN - SCOPUS:85028992466
SN - 1069-6563
VL - 24
SP - 1072
EP - 1079
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 9
ER -