The utility of bedside ultrasound in the detection of a ruptured globe in a porcine model.

BACKGROUND: Recent case reports have shown that ultrasonography can be used to diagnose ocular pathology in an emergency setting. Ultrasound may be especially useful when periorbital edema and pain interfere with the examination of the post-traumatic eye. OBJECTIVE: This study evaluated the ability of emergency physicians to detect a ruptured globe in an ex-vivo porcine model. METHODS: Following a brief training lecture, 15 emergency medicine residents and 4 emergency medicine attending physicians used ultrasonography to evaluate 18 porcine eyes, randomized as normal, ruptured, or completely devoid of vitreous humor. The consequences of ultrasound applanation with this method were evaluated by measuring intraocular pressure changes with and without a 1mm clear plastic shield. RESULTS: Our study participants were able to identify abnormal eyes with a sensitivity of 79% (95% CI 73% to 84%) and a specificity of 51% (95% CI 41% to 61%). Intraocular pressure increased 5% with ultrasound applanation, though with a 1mm thick plastic shield there was no measurable change. CONCLUSIONS: Ultrasound imaging may be a future modality to be used by trained emergency physicians to expedite the identification of a rupture globe, but it is unlikely to replace more definitive imaging techniques. The use of a clear plastic barrier in this porcine model prevents an increase in intra-ocular pressure without affecting image quality, and should be used in any future studies on this method.

Point-of-care testing for drugs of abuse in an urban emergency department.

Point-of-care testing (POCT) has been used for illicit substance screening in several settings, primarily in law enforcement and drug treatment centers. In this study, we evaluate the use of this screening approach in the emergency department (ED) of a tertiary-care, urban medical center. Aliquots of urine specimens were tested simultaneously by a POCT device (OnTrak) and by a laboratory-based screening system (Triage). The outcomes that were compared included (a) time to completion of test, (b) time until the physician received the results, and (c) concordance of results obtained by the two analytical methods. The study population included pediatric (< or = 21 yr) and adult (>21 yr) patients; data from 170 subjects were evaluated. We observed significant reductions (p < 0.001) in turnaround time (both the time to completion and the time to physician). Concordance between the results obtained by the two analytical methods was excellent (97% agreement for cocaine; 99% agreement for marijuana, opiates, and amphetamines, p < 0.001 for all categories). Cost analysis showed at least 37.5% decrease in cost per analyte when urine samples were tested by the POCT device, compared to the laboratory-based screening system. We conclude that POCT for drugs of abuse in the ED was equally effective, less costly, and more rapid than the laboratory-based screening system.