Journal Article

Diagnostic test accuracy of ultrasound for orbital cellulitis: A systematic review

Cornelia M. Borkhoff, Mohammed Rashidul Anwar, Peter J. Gill, Sanjay Mahant, Patricia C. Parkin, Toni Agbaje-Ojo, Quenby Mahood

2023

Overview

Periorbital and orbital cellulitis are inflammatory conditions of the eye that can be difficult to distinguish using clinical examination alone. Computer tomography (CT) scans are often used to differentiate these two infections and to evaluate for complications. Orbital ultrasound (US) could be used as a diagnostic tool to supplement or replace CT scans as the main diagnostic modality. No prior systematic review has evaluated the diagnostic test accuracy (DTA) of ultrasound compared to cross-sectional imaging. To conduct a systematic review of studies evaluating the DTA of orbital ultrasound compared with cross-sectional imaging, to diagnose orbital cellulitis. MEDLINE, EMBASE, CENTRAL, and Web of Science were searched from inception to August 10, 2022. All study types were included that enrolled patients of any age with suspected or diagnosed orbital cellulitis who underwent ultrasound and a diagnostic reference standard (i.e., CT or magnetic resonance imaging [MRI]). Two authors screened titles/abstracts for inclusion, extracted data, and assessed the risk of bias. Of the 3548 studies identified, 20 were included: 3 cohort studies and 17 case reports/series. None of the cohort studies directly compared the diagnostic accuracy of ultrasound with CT or MRI, and all had high risk of bias. Among the 46 participants, diagnostic findings were interpretable in 18 (39%) cases which reported 100% accuracy. We were unable to calculate sensitivity and specificity due to limited data. In the descriptive analysis of the case reports, ultrasound was able to diagnose orbital cellulitis in most (n = 21/23) cases. Few studies have evaluated the diagnostic accuracy of orbital ultrasound for orbital cellulitis. The limited evidence based on low quality studies suggests that ultrasound may provide helpful diagnostic information to differentiate orbital inflammation. Future research should focus studies to determine the accuracy of orbital US and potentially reduce unnecessary exposure to radiation.

• Publisher: Public Library of Science (PLoS),Public Library of Science
• Subject: Abscesses / Accuracy / Bacterial eye infections / Bias / Biology and Life Sciences / Case reports / Cellulitis / Cohort analysis / Comparative analysis / Complications / Computed tomography / CT imaging / Diagnosis / Diagnostic imaging / Diagnostic tests / Diagnostic Tests, Routine / Differential thermal analysis / Emergency medical care / Evaluation / General anesthesia / Health aspects / Humans / Infections / Inflammation / Magnetic resonance / Magnetic Resonance Imaging / Medical diagnosis / Medical imaging / Medical research / Medical tests / Medicine / Medicine and Health Sciences / Medicine, Experimental / Meta-analysis / Orbital Cellulitis / Pediatrics / Point of care testing / Q / R / Radiation / Radiation effects / Radionuclide Imaging / Research and Analysis Methods / Research Article / Risk assessment / Science / Sensitivity and Specificity / Systematic review / Ultrasonic imaging / Ultrasonography / Ultrasound