None listed
Conditions
Brief summary
Fundoscopy (looking at the back of the eye) is extremely valuable but rarely done as the traditional direct ophthalmoscope is hard to use. The consequence is delay to diagnosis or missed diagnosis of potentially critical eye and whole body conditions. Digital fundus photography has been demonstrated as a superior alternative to direct ophthalmoscopy, detecting problems amongst 10-18% of relevant emergency department (ED) patients in metropolitan hospitals. We aim to determine how often fundus photography improves the management of patients, and the prevalence of fundus pathology in a regional setting. We hypothesise that fundus photography will: 1. change the management of patients in the ED; 2. be more accurate in diagnosis than direct ophthalmoscopy; 3. detect a rate of pathology similar to that found in metropolitan EDs.
Interventions
Intervention Name: Non-mydriatic fundus photography (NMFP)
*RetinaVUE registered trade mark (Welch Allyn, Macquarie Park, Australia): portable camera provided to enrolled patients at the bedside ED
*performed in the ED by a nurse, physician or medical student researcher with prior computer-based and face-to-face NMFP training
*administered once during the ED admission, taking approximately 2-10 minutes for complete examination of both eyes
*digital fundus images are loaded to the study electroni
Intervention Name: Non-mydriatic fundus photography (NMFP) *RetinaVUE registered trade mark (Welch Allyn, Macquarie Park, Australia): portable camera provided to enrolled patients at the bedside ED *performed in the ED by a nurse, physician or medical student researcher with prior computer-based and face-to-face NMFP training *administered once during the ED admission, taking approximately 2-10 minutes for complete examination of both eyes *digital fundus images are loaded to the study electronic medical record *during daytime hours (Monday-Friday 8:30-5pm) results of a direct ophthalmoscopy examination and baseline management plan documentation are recorded (see comparator intervention), THEN fundus images are provided to the treating emergency physician and interpretation and management plan changes are recorded on a study-specific questionnaire *outside daytime study hours ED physicians were free to use the NMFP or DO as they wished *fundus images are then reviewed by the local ophthalmology team (and a study investigator) *any urgent clinical considerations discovered on routine image review are discussed with the treating ED team *screening protocol adherence monitored by comparing enrolment data with hospital records of ED admissions
Sponsors
Discipline of Clinical Ophthalmology & Eye Health, Faculty of Medicine & Health, University of Sydney
Study design
Allocation
Non-randomised trial
Intervention model
Crossover
Primary purpose
Diagnosis
Masking
Blinded (masking used) (Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
4 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients presenting to ED Monday-Friday between the hours of 8am - 5pm with: *Headache *New neurological disturbance (defined as motor and/or sensory deficits, speech impairment or dizziness) *Visual disturbance *Hypertensive urgency (defined as a diastolic blood pressure over 110 mmHg, and/or a systolic blood pressure over 180 mmHg)
Exclusion criteria
* Unable to give informed consent: normal guardianship consent hospital regulations will be followed * Medically unstable: once immediate care is provided and the patient is deemed medically stable, inclusion may be considered * Self-discharge from ED prior to medical review
Outcome results
None listed