• Hamish P Dunn, Kai Zong Teo, James Wp Smyth, Lakni S Weerasinghe, Julia Costello, Preethi Pampapathi, Lisa Keay, Tim Green, Matthew Vukasovic, Beau B Bruce, Nancy J Newman, Valérie Biousse, Andrew J White,... more Peter McCluskey, and Clare L Fraser. less
• Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
• Emerg Med Australas. 2021 Apr 1; 33 (2): 302-309.

ObjectiveTo 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.MethodsProspective 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.ResultsA 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.ConclusionsFundus 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.© 2020 Australasian College for Emergency Medicine.

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