The Clinical Validity of the Spontaneous Retinal Venous Pulsation
The Clinical Validity of the Spontaneous Retinal Venous Pulsation
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DOI：
10.1097/wno.0b013e3182622207
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发表时间：
2013-03-01
影响因子：
2.9
通讯作者：
White, Richard Patrick
中科院分区：
文献类型：
--
作者：
Wong, Sui Hsien;White, Richard Patrick
背景资料：“自发性视网膜静脉搏动（SVP）的存在排除颅内压升高”的临床格言的有效性以前尚未得到验证。我们着手确定的特异性和阳性预测值（PPV）的存在，SVP表明正常颅内压（ICP）在常规的临床setting.Methods：我们前瞻性招募患者进行腰椎穿刺（LP），和2名临床医生是盲目的LP和脑脊液开放压力（OP）的适应症。结果：我们的队列中有106例患者，中位年龄为44岁（范围，18-79岁），中位体重指数为27.5 kg/m2（范围，18-48 kg/m2）。106例患者中有94例（88.7%）存在SVP。106中的13（12.3%）患者有高OP 13例高OP患者中11例（86%）存在SVP。排除ICP升高的SVP存在的95%置信区间为0.89特异性0.15（0.05-0.37），阳性预测值0.88（0.87-0.9），阴性预测值0.17（0.05-0.4）。观察者间SVP的一致性为中等（kappa = 0.42）。结论：尽管SVP排除ICP升高的敏感性和PPV很高，但这不是绝对的。部分ICP高的患者可出现SVP。依靠SVP的存在来排除升高的ICP可能会给人一种虚假的放心感。Journal of Neuro-Ophthalmology 2013;33：17-20 doi：10.1097/WNO.0b013e3182622207（C）2012 by North American Neuro-Ophthalmology Society
Background: The validity of the clinical dictum "the presence of spontaneous retinal venous pulsation (SVP) excludes raised intracranial pressure" has not been previously tested. We set out to determine the specificity and positive predictive value (PPV) of the presence of SVP to indicate normal intracranial pressure (ICP) in a routine clinical setting.Methods: We prospectively recruited patients undergoing lumbar puncture (LP), and 2 clinicians were blinded to the indications for LP and cerebrospinal fluid opening pressure (OP). Interobserver reliability was assessed.Results: There were 106 patients in our cohort with a median age of 44 years (range, 18-79 years) and median body mass index of 27.5 kg/m(2) (range, 18-48 kg/m(2)). SVP was present in 94 of 106 patients (88.7%). Thirteen of 106 (12.3%) patients had high OP (>= 30 cmH(2)O), and SVP was present in 11 of 13 patients (86%) with high OP. The sensitivity (95% confidence interval) of the presence of SVP to exclude raised ICP was 0.89 (0.88-0.92), specificity of 0.15 (0.05-0.37), PPV of 0.88 (0.87-0.9), and negative predictive value of 0.17 (0.05-0.4). Interobserver agreement was moderate for SVP (kappa = 0.42).Conclusions: Although the sensitivity and PPV of the presence of SVP to exclude raised ICP is high, it is not absolute. SVP can be seen in some patients with high ICP. Relying on the presence of SVP to exclude raised ICP may give a false sense of reassurance. Journal of Neuro-Ophthalmology 2013;33:17-20 doi: 10.1097/WNO.0b013e3182622207 (C) 2012 by North American Neuro-Ophthalmology Society