Computed tomography in the diagnosis and prognosis of open-globe injuries
Section snippets
Methods
Two-hundred patients who underwent preoperative CT scanning for eye injuries between 1989 and 1993 were identified retrospectively from the Johns Hopkins Hospital Radiology Data Bank. Of these, 167 films were obtained. Clinical and/or surgical diagnoses of open globe injuries were obtained from hospital charts and a database of patients with open globe injury treated at the Wilmer Eye Institute.11 The CT scans from patients were placed in similar film jackets so the observers were blind to
Results
The sensitivity of the CT scan in predicting whether an eye had an open globe injury was calculated for each observer and ranged between 73% and 79% (Table 2). The specificity of the CT scan for correctly identifying eyes without open globe injuries ranged from 86% to 97%. The positive predictive value ranged from 88% to 97%, with a calculated overall positive predictive value of 95%. The overall sensitivity and specificity obtained by combining observations from all three observers was 75% and
Discussion
CT is available in most hospital emergency departments and has become a standard component in the workup of cases of severe head and facial trauma. A single study allows clinicians to assess the intracranial space, the presence of facial or orbital fractures, ocular injuries, and more. Performance of CT scan requires minimal patient cooperation and can be done in the presence of life support equipment. Unlike magnetic resonance imaging, there are few if any contraindications such as metallic
Conclusions
CT scan is an important test in the diagnosis and prognosis of open globe injury. Although the sensitivity of CT may not be high enough to be used as an isolated screening tool, it has significant clinical usefulness as an adjunct to clinical examination and provides prognostic information for these types of injuries with minimal disturbance to the globe.
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