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Jindal A, Brandao-de-Resende C, Neo YN, Melo M, Day AC. Enhancing Ophthalmic Triage: identification of new clinical features to support healthcare professionals in triage. Eye (Lond) 2024; 38:2536-2544. [PMID: 38627545 PMCID: PMC11385555 DOI: 10.1038/s41433-024-03070-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/07/2024] [Accepted: 04/05/2024] [Indexed: 09/11/2024] Open
Abstract
OBJECTIVE To investigate which features from a patient's history are either high or low risk that could support healthcare professionals in ophthalmic emergency triage. METHODS Prospective, 12,584 visits from 11,733 adult patients attending an Accident and Emergency department at a single tertiary centre were analysed. Data were collected by ophthalmic nurses working in triage, using an online form from August 2021 to April 2022. Multivariate analysis (MVA) was conducted to identify which features from the patients' history would be associated with emergency care. RESULTS This study found that 45.5% (5731 patient visits (PV)) required a same day eye emergency examination (SDEE), 11.3% (1416 PV) needed urgent care, and 43.2% (5437 PV) were appropriate for elective consultations with a GP or optometrist. The MVA top ten features that were statistically significant (p < 0.05) that would warrant SDEE with odds ratio (95% CI) were: bilateral eye injury 36.5 [15.6-85.5], unilateral eye injury 25.8 [20.9-31.7], vision loss 4.8 [2.9-7.8], post-operative ophthalmic ( < 4 weeks) 4.6 [3.8-5.7], contact lens wearer 3.9 [3.3-4.7], history of uveitis 3.9 [3.3-4.7], photophobia 2.9 [2.4-3.6], unilateral dark shadow/curtain in vision 2.4 [1.8-3.0], unilateral injected red eye 2.0 [1.8-2.2] and rapid change in visual acuity 1.8 [1.5-2.2]. CONCLUSION This study characterises presenting features covering almost 100 ophthalmic acute presentations that are commonly seen in emergency and elective care. This information could supplement current red flag indicators and support healthcare professionals in ophthalmic triage. Further research is required to evaluate the cost effectivity and safety of our findings for triaging acute presentations.
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Affiliation(s)
- Anish Jindal
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
- Department of Brain Sciences, Institute of Ophthalmology, University College London, London, UK.
| | - Camilo Brandao-de-Resende
- Department of Brain Sciences, Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Clinical Research Facility, Moorfields Eye Hospital, London, United Kingdom
| | - Yan Ning Neo
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Mariane Melo
- NIHR Moorfields Clinical Research Facility, Moorfields Eye Hospital, London, United Kingdom
| | - Alexander C Day
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Department of Brain Sciences, Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Clinical Research Facility, Moorfields Eye Hospital, London, United Kingdom
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Poret J, Fauviaux E, Jany B, Bourges JL, Tran THC. [Creation and evaluation of a triage survey for ophthalmology emergencies]. J Fr Ophtalmol 2024; 47:104017. [PMID: 37945430 DOI: 10.1016/j.jfo.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE The demand for eye care is growing continuously. We created a triage survey system, based on categories of severity, to optimize first line patient care in an ophthalmology emergency department. METHODS This cross-sectional study was carried out from July 7th, 2021 to October 10th, 2021. During this period, a survey was taken by patients upon arrival to the emergency department. Patients completed the survey by ticking boxes that best fitted their situation. The survey classified patients into three categories of severity: GREEN, ORANGE and RED. A chart review was performed to record the final diagnoses. The severity of each diagnosis was rated according to the Base Score. This score was then compared to the level of severity as determined by our survey to calculate the agreement between the two methods. RESULTS We collected 767 survey forms, with an 80% response rate. We noted 78 different diagnoses. We scored 564 patients as GREEN, 107 as ORANGE and 96 as RED. The sensitivity rates for the green, orange and red categories were 90%, 70% and 96% respectively. The specificity rates were 90% for the green category, 95% for orange and 94% for red, with good agreement (kappa coefficient=0.70). CONCLUSION Our results suggest that a self-administered survey could be useful as a triage tool for common ocular emergencies. This survey could be performed better if complete by the patients with the assistance of emergency staff. Potentially helpful for high flow structures such as university-based hospitals, this triage survey might also help in comprehensive clinics or emergency departments.
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Affiliation(s)
- J Poret
- Service d'ophtalmologie, centre hospitalier universitaire d'Amiens, 1, rue du Professeur-Christian-Cabrol, 8000 Amiens, France.
| | - E Fauviaux
- Service d'ophtalmologie, centre hospitalier universitaire d'Amiens, 1, rue du Professeur-Christian-Cabrol, 8000 Amiens, France
| | - B Jany
- Service d'ophtalmologie, centre hospitalier universitaire d'Amiens, 1, rue du Professeur-Christian-Cabrol, 8000 Amiens, France
| | - J L Bourges
- Ophtalmopôle de Paris, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris Cité, Paris, France
| | - T H C Tran
- Service d'ophtalmologie, centre hospitalier universitaire d'Amiens, 1, rue du Professeur-Christian-Cabrol, 8000 Amiens, France
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Varas J, Campos MÁ, Tapia E, Sanhueza JL, Salazar C, Vergara N, Tapia N, Mantero G, Bustamante P. Visual-functional impact of people affected by severe ocular trauma during social protests in Chile in 2019. Int Ophthalmol 2024; 44:77. [PMID: 38351240 DOI: 10.1007/s10792-024-02969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/04/2023] [Indexed: 02/16/2024]
Abstract
PURPOSE To determine the impact on the functionality associated with visual loss (VFIP) in people with severe ocular trauma (SOT) caused by kinetic impact projectiles used in police crowd control through a prioritization tool in people admitted to a rehabilitation program in Santiago de Chile from December 02, 2019, to November 13, 2020. METHODS A cross-sectional descriptive study of SOT victims (N = 85), average age 31.4 ± 11.9. The data were recorded through a new 9-item screening instrument for assessment and prioritization of rehabilitation created for this emergency scenario. RESULTS The impact of the use of kinetic weapons resulted in monocular blindness in the majority of those affected (n = 68; 80.0%). The highest VFIP observed was among young men from lower social strata. There were extreme difficulties in the performance of productive tasks (occupational and/or educational) (n = 42; 49.4%) and the pursuit of hobbies and pastimes (n = 23; 27.1%), as well as a high difficulty in adapting to changes in brightness (n = 29; 34.1%) and handling objects accurately (n = 22; 25.9%). CONCLUSION The use of kinetic weapons for crowd control resulted in high and extreme VFIP and, in most cases, monocular blindness, causing major difficulties in work, study, and development of hobbies and pastimes in the affected population, highlighting the urgent need for effective rehabilitative care, which requires special attention in order to generate an adequate rehabilitation program. The use of kinetic weapons for crowd control contravenes international goals, policies, and plans set by the WHO and the International Agency for the Prevention of Blindness on strategies to prevent avoidable blindness worldwide until 2020. It is essential to ban the use of these weapons in Chile and worldwide, as well as to revise police protocols for crowd control.
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Affiliation(s)
- Joaquín Varas
- Department of Occupational Therapy and Occupational Science, Faculty of Medicine, Universidad de Chile, Independencia 1027, Santiago, Chile
| | - Miguel Ángel Campos
- Department of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia 1027, 8380453, Santiago, Chile
- Department of Ophthalmology, Hospital Del Salvador, Avenida Salvador 364, Santiago, Chile
| | - Eric Tapia
- Department of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia 1027, 8380453, Santiago, Chile
- Instituto de Investigación y Postgrado, Facultad de Medicina y Ciencias de la Salud, Universidad Central de Chile, Lord Cochrane 416, Santiago, Chile
| | - José Luis Sanhueza
- Department of Ophthalmology, Hospital Del Salvador, Avenida Salvador 364, Santiago, Chile
| | - Claudia Salazar
- School of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia 1027, Santiago, Chile
| | - Nayadet Vergara
- School of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia 1027, Santiago, Chile
| | - Nicole Tapia
- Department of Ophthalmology, Hospital Del Salvador, Avenida Salvador 364, Santiago, Chile
| | - Gianinna Mantero
- Department of Ophthalmology, Hospital Del Salvador, Avenida Salvador 364, Santiago, Chile
| | - Patricio Bustamante
- Department of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia 1027, 8380453, Santiago, Chile.
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Dixitha V, Babu M, Sabhahit SV. A study on knowledge, attitude, and practices toward ophthalmic emergencies among fresh medical graduates in India. Oman J Ophthalmol 2024; 17:65-71. [PMID: 38524326 PMCID: PMC10957055 DOI: 10.4103/ojo.ojo_338_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 08/11/2023] [Accepted: 01/02/2024] [Indexed: 03/26/2024] Open
Abstract
PURPOSE The purpose of this study was to evaluate and estimate the knowledge, attitude, and practices of Indian fresh medical graduates with respect to ophthalmic emergencies. MATERIALS AND METHODS This cross-sectional study was conducted on 1300 participants who had completed compulsory rotatory residential internship with the help of a questionnaire distributed through social platforms. The Chi-square and Pearson's coefficient relation tests were used. Statistical analysis was done using IBM SPSS. P <0.05 was taken as the level of statistical significance. RESULTS Good knowledge proportionately corresponded to a good attitude with statistical significance (P = 0.000). Participants with good practice also had a good attitude with significance (P = 0.001). Good knowledge participants who managed ophthalmic emergencies were statistically significant than that of participants with poor knowledge and managed ophthalmic emergencies, 15.72%. (χ2 = 16.653, P = 0.000). Attitude toward confidence in the management of ophthalmic emergencies and their willingness in undergoing training was significant (χ2 = 43.8, P = 0.000). CONCLUSION Educating and training fresh medical graduates can help in the management and mitigation of ophthalmic emergencies to reduce ocular morbidity and prevent blindness to a greater degree.
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Affiliation(s)
- V. Dixitha
- Department of Ophthalmology, KVG Medical College and Hospital, Sullia, Karnataka, India
| | - Mahesh Babu
- Department of Ophthalmology, KVG Medical College and Hospital, Sullia, Karnataka, India
| | - Shruti Vinod Sabhahit
- Department of Ophthalmology, KVG Medical College and Hospital, Sullia, Karnataka, India
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Chen J, Wu X, Li M, Liu L, Zhong L, Xiao J, Lou B, Zhong X, Chen Y, Huang W, Meng X, Gui Y, Chen M, Wang D, Dongye M, Zhang X, Cheung CY, Lai IF, Yan H, Lin X, Zheng Y, Lin H. EE-Explorer: A Multimodal Artificial Intelligence System for Eye Emergency Triage and Primary Diagnosis. Am J Ophthalmol 2023; 252:253-264. [PMID: 37142171 DOI: 10.1016/j.ajo.2023.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To develop a multimodal artificial intelligence (AI) system, EE-Explorer, to triage eye emergencies and assist in primary diagnosis using metadata and ocular images. DESIGN A diagnostic, cross-sectional, validity and reliability study. METHODS EE-Explorer consists of 2 models. The triage model was developed from metadata (events, symptoms, and medical history) and ocular surface images via smartphones from 2038 patients presenting to Zhongshan Ophthalmic Center (ZOC) to output 3 classifications: urgent, semiurgent, and nonurgent. The primary diagnostic model was developed from the paired metadata and slitlamp images of 2405 patients from ZOC. Both models were externally tested on 103 participants from 4 other hospitals. A pilot test was conducted in Guangzhou to evaluate the hierarchical referral service pattern assisted by EE-Explorer for unspecialized health care facilities. RESULTS A high overall accuracy, as indicated by an area under the receiver operating characteristic curve (AUC) of 0.982 (95% CI, 0.966-0.998), was obtained using the triage model, which outperformed the triage nurses (P < .001). In the primary diagnostic model, the diagnostic classification accuracy (CA) and Hamming loss (HL) in the internal testing were 0.808 (95% CI 0.776-0.840) and 0.016 (95% CI 0.006-0.026), respectively. In the external testing, model performance was robust for both triage (average AUC, 0.988, 95% CI 0.967-1.000) and primary diagnosis (CA, 0.718, 95% CI 0.644-0.792; and HL, 0.023, 95% CI 0.000-0.048). In the pilot test in the hierarchical referral settings, EE-explorer demonstrated consistently robust performance and broad participant acceptance. CONCLUSION The EE-Explorer system showed robust performance in both triage and primary diagnosis for ophthalmic emergency patients. EE-Explorer can provide patients with acute ophthalmic symptoms access to remote self-triage and assist in primary diagnosis in unspecialized health care facilities to achieve rapid and effective treatment strategies.
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Affiliation(s)
- Juan Chen
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Xiaohang Wu
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Mingyuan Li
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Lixue Liu
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Liuxueying Zhong
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Jun Xiao
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Bingsheng Lou
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Xingwu Zhong
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong; Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University (X.Zho., Y.C., W.H., H.L.), Haikou, Hainan
| | - Yanting Chen
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University (X.Zho., Y.C., W.H., H.L.), Haikou, Hainan
| | - Wenbin Huang
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University (X.Zho., Y.C., W.H., H.L.), Haikou, Hainan
| | - Xiangda Meng
- Tianjin Medical University General Hospital (X.M., H.Y.), Tianjin
| | - Yufei Gui
- First Affiliated Hospital of Kunming Medical University, Kunming (Y.G.), Yunnan
| | - Meizhen Chen
- Guangzhou Aier Eye Hospital (M.C.), Guangzhou, Guangdong
| | - Dongni Wang
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Meimei Dongye
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Xulin Zhang
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong (C.Y.C.), Hong Kong
| | - Iat Fan Lai
- Ophthalmic Center, Kiang Wu Hospital (I.F.L.), Macao SAR, Macao
| | - Hua Yan
- Tianjin Medical University General Hospital (X.M., H.Y.), Tianjin
| | - Xiaofeng Lin
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Yongxin Zheng
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong
| | - Haotian Lin
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases (J.C., X.W., M.L., L.L., L.Z., J.X., B.L., X.Zho., D.W., M.D., X.Zha., X.L., Y.Z., H.L.), Guangzhou, Guangdong; Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University (X.Zho., Y.C., W.H., H.L.), Haikou, Hainan; Center for Precision Medicine and Department of Genetics and Biomedical Informatics, Zhongshan School of Medicine, Sun Yat-sen University (H.L.), Guangzhou, Guangdong, China.
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Meer E, Ramakrishnan MS, Whitehead G, Leri D, Rosin R, VanderBeek B. Validation of an Automated Symptom-Based Triage Tool in Ophthalmology. Appl Clin Inform 2023; 14:448-454. [PMID: 36990454 PMCID: PMC10247304 DOI: 10.1055/a-2065-4613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Acute care ophthalmic clinics often suffer from inefficient triage, leading to suboptimal patient access and resource utilization. This study reports the preliminary results of a novel, symptom-based, patient-directed, online triage tool developed to address the most common acute ophthalmic diagnoses and associated presenting symptoms. METHODS A retrospective chart review of patients who presented to a tertiary academic medical center's urgent eye clinic after being referred for an urgent, semi-urgent, or nonurgent visit by the ophthalmic triage tool between January 1, 2021 and January 1, 2022 was performed. Concordance between triage category and severity of diagnosis on the subsequent clinic visit was assessed. RESULTS The online triage tool was utilized 1,370 and 95 times, by the call center administrators (phone triage group) and patients directly (web triage group), respectively. Of all patients triaged with the tool, 8.50% were deemed urgent, 59.2% semi-urgent, and 32.3% nonurgent. At the subsequent clinic visit, the history of present illness had significant agreement with symptoms reported to the triage tool (99.3% agreement, weighted kappa = 0.980, p < 0.001). The triage algorithm also had significant agreement with the severity of the physician diagnosis (97.0% agreement, weighted kappa = 0.912, p < 0.001). Zero patients were found to have a diagnosis on exam that should have corresponded to a higher urgency level on the triage tool. CONCLUSION The automated ophthalmic triage algorithm was able to safely and effectively triage patients based on symptoms. Future work should focus on the utility of this tool to reduce nonurgent patient load in urgent clinical settings and to improve access for patients who require urgent medical care.
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Affiliation(s)
- Elana Meer
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States
| | - Meera S. Ramakrishnan
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Gideon Whitehead
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Damien Leri
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Penn Medicine Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
| | - Roy Rosin
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Penn Medicine Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
| | - Brian VanderBeek
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
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Chen J, Chen CM, Zheng Y, Zhong L. Characteristics of eye-related emergency visits and triage differences by nurses and ophthalmologists: Perspective from a single eye center in southern China. Front Med (Lausanne) 2023; 10:1091128. [PMID: 37007786 PMCID: PMC10061012 DOI: 10.3389/fmed.2023.1091128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE To describe characteristics of eye-related emergency department (ED) visits and investigate differences in priorities assigned to patients by triage nurses and ophthalmologists. METHODS A prospective survey was conducted at the ED of Zhongshan Ophthalmic Center from January 1, 2021, to May 31, 2021. Clinical data from patients with acute ophthalmic conditions lasting less than 7 days were collected via a standard questionnaire and the urgency levels assigned by nurses and physicians were also recorded. Binary logistic regression was performed to identify characteristics associated with truly emergency conditions and up- or down-triage. RESULTS A total of 1907 patients were enrolled, with 582 (30.5%) classified as "non-emergency." Red eye (69.7%), eye pain (53.0%), ocular trauma (44.1%), tearing (43.6%), and blurred vision (43.1%) were the most common complaints. Truly emergency tended to be male (OR 2.019, p < 0.001) and with unilateral eye involvement (OR 2.992, p < 0.001). Nurses prioritized conjunctival, scleral, closed ocular trauma and eyelid diseases over doctors while giving less priority to open ocular trauma, cornea, uveitis, and vitreoretinal diseases (p < 0.05). Overemphasis on mild blurred vision (OR 3.718, p = 0.001) and insufficient understanding of conjunctival diseases without red eye (OR 0.254, p = 0.001) were associated with conjunctival disease "up-triage." Insufficient awareness of moderate and severe blurred vision was associated with "down-triage" for ocular trauma (OR 3.475, p = 0.001 and OR 2.422, p = 0.020, respectively). CONCLUSION Ophthalmic EDs are typically flooded with patients suffering from acute ocular problems, with a considerable portion for non-emergency conditions. The identification of characteristics associated with truly emergency cases and nurses' triage preferences is valuable in providing target guidance for future ED practice and facilitating the proper allocation of emergency resources.
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Affiliation(s)
| | | | - Yongxin Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Liuxueying Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
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AlSamnan M, AlAmry M, aldossari S, Talea M, Khandekar R, AlGhadeer H. Validity of an Ocular Emergency Triage System Compared to the Existing Grading System at the Emergency Unit of a Tertiary Eye Hospital in Saudi Arabia. Clin Ophthalmol 2023; 17:527-534. [PMID: 36789291 PMCID: PMC9922481 DOI: 10.2147/opth.s397504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
Purpose To assess true ocular emergencies based on the ocular emergency triage system compared to the existing method of serving patients "first come first serve" by attending ophthalmology resident and review the validity of the triage system by ophthalmic subspecialty. Methods In this cross-sectional study of validity, new patients attending the ocular emergency department of a tertiary eye hospital in 2021-2022 were examined by ophthalmology resident. The time required for registration, an eye exam, and total time in the emergency unit was determined. Using ophthalmic triage criteria, same patients were reviewed by senior ophthalmologist to categorize them as "top emergencies", "emergencies", and "not an emergency." The reviewer was masked about grading by an ophthalmology resident. The agreement rate for true emergencies by both methods of grading was calculated by subspecialty. Results One thousand patients with ocular emergencies were evaluated. The median overall time spent in the emergency unit was 92 minutes [interquartile range (IQR): 56; 142]. The revised triage system estimated 85% were "true emergencies." Using both the revised triage and conventional methods, 172 (17.2%) patients were not considered as having an ocular emergency. The difference in patients grouped into "emergencies" (34.3% vs 21.4%) and "top emergencies" (46.5% vs 60.4%) was significant (P<0.001) between methods. Uveitis (72%) had the lowest agreement between methods and pediatric ophthalmology (100%) had the highest agreement. Conclusion The revised ophthalmic triage system seems to be more efficient than existing method. Subspecialist ophthalmologists may provide quicker and better treatment if ophthalmic emergency patients are prioritized utilizing the proposed redesigned triage method.
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Affiliation(s)
- Mazen AlSamnan
- Emergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Mohammed AlAmry
- Emergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Saif aldossari
- Ophthalmology Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Mohammed Talea
- Ophthalmology Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Rajiv Khandekar
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Huda AlGhadeer
- Emergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia,Correspondence: Huda AlGhadeer, Emergency Department, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh, 11462, Saudi Arabia, Tel +966 1 4821234 ext. 2500, Email
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Chantrey J, Ryder TJ. Assessing Adult Patients with Facial Deformities for Injectable Treatment: Do Current Classification Systems and Methodologies Meet Important Patient Needs? Dermatol Surg 2022; 48:1185-1190. [PMID: 36342249 DOI: 10.1097/dss.0000000000003554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Many individuals are affected by facial deformities. Injectable aesthetic treatments can often be used to improve appearance and/or dynamic function. However, to best meet the needs of these patients, broadly applicable methodologies are required for classifying the deformity, assessing severity, and developing a treatment strategy. OBJECTIVE To assess whether any published systems could be used for this purpose. METHODS Thirty-eight searches were conducted in PubMed (1999-2019; in English). Forty-two publications were identified describing novel classification systems for adult facial deformity. They were analyzed against a checklist of 10 characteristics defining an "optimal" system-based on appropriate anatomical coverage, wide usability across types of deformity, user-friendliness, applicable underlying methodology, and ability to guide treatment with injectables. RESULTS None of the systems met more than 7 of the 10 checklist criteria; none were usable across multiple types of deformity or provided a recommendation for treatment with injectables. CONCLUSION There remains a need for a broadly applicable system for classifying adult facial deformities ahead of injectable therapy. The checklist provides a developmental framework. With the increasing popularity and accessibility of injectables, this diverse and complex demographic is at risk of mismanagement without superior methods for devising treatment strategies.
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Park SS, Vij R, Wu J, Zarrin B, Moon JY, Oliveira J, Schultz JS, Shrivastava A. A Systematic Analysis of the Impact of an Ambulatory Ophthalmology Urgent Care Clinic. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2022. [DOI: 10.1055/s-0041-1741464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Importance A same-day ophthalmic urgent care clinic can provide efficient eye care, a rich educational environment, and can improve patient experience.
Objective The aim of this study was to systematically evaluate volume, financial impact, care metrics, and the breadth of pathology of urgent new patient encounters based on their site of initial presentation.
Design, Setting, and Participants A retrospective analysis was performed on consecutive urgent new patient evaluations in our same-day triage clinic at the Henkind Eye Institute at Montefiore Medical Center between February 2019 and January 2020. The cohort of patients who presented directly to this urgent care clinic were referred to as the “TRIAGE” group. Patients who initially presented to an emergency department (ED), and were subsequently referred to our triage clinic, are referred to as the “ED + TRIAGE” group.
Main Outcomes and Measures Visits were evaluated on a variety of metrics, including diagnosis, duration, charge, cost, and revenue. Furthermore, return to the ED or inpatient admission was documented.
Results Of 3,482 visits analyzed, 2,538 (72.9%) were in the “TRIAGE” group. Common presenting diagnoses were ocular surface disease (n = 486, 19.1%), trauma (n = 342, 13.5%; most commonly surface abrasion n = 195, 7.7%), and infectious conjunctivitis (n = 304, 12.0%). Patients in the “TRIAGE” group, on average, were seen 184.6% faster (158.2 vs. 450.2 minutes) than patients in the “ED + TRIAGE” group (p < 0.001). The “ED + TRIAGE” group were furthermore found to generate 442.1% higher charges ($870.20 vs. 4717.70) and were associated with 175.1% higher cost ($908.80 vs. 330.40) per patient. The hospital was found to save money when noncommercially insured patients with ophthalmic complaints presented to the triage clinic instead of the ED. Patients seen in the triage clinic had a low rate of readmission to the ED (n = 42, 1.2%).
Conclusions and Relevance A same-day ophthalmology triage clinic provides efficient care, while providing a rich learning environment for residents. Less wait time with direct access to subspecialist care can help improve quality, outcome, and satisfaction metrics.
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Affiliation(s)
- Sally S.E. Park
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
| | - Rohin Vij
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jeff Wu
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
| | - Bryan Zarrin
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
| | - Jee-Young Moon
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jason Oliveira
- Department of Financial Planning and Analysis, Montefiore Health System, Tarrytown, New York
| | - Jeffrey S. Schultz
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
| | - Anurag Shrivastava
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York
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Lin CH, Ling XC, Wu WC, Chen KJ, Hsieh CH, Liao CH, Fu CY. The Role of Nonophthalmologists in the Primary Evaluation of Head Injury Patients with Ocular Injuries. J Pers Med 2021; 11:jpm11111220. [PMID: 34834572 PMCID: PMC8623258 DOI: 10.3390/jpm11111220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose—Visual complaints are common in trauma cases. However, not every institution provides immediate ophthalmic consultations 24 h per day. Some patients may receive an ophthalmic consultation but without positive findings. We tried to evaluate risk factors for ocular emergencies in trauma patients. Then, the ophthalmologists could be selectively consulted. Methods—From January 2019 to December 2019, head injuries patients concurrent with suspected ocular injuries were retrospectively reviewed. All of the patients received comprehensive ophthalmic examinations by ophthalmologists. Patients with and without ocular injuries were compared. Specific ophthalmic evaluations that could be primarily performed by primary trauma surgeons were also analyzed in detail. Results—One hundred forty cases were studied. Eighty-nine (63.6%) patients had ocular lesions on computed tomography (CT) scans or needed ophthalmic medical/surgical intervention. Near 70% (69.7%, 62/89) of patients with ocular injuries were diagnosed by CT scans. There was a significantly higher proportion of penetrating injuries in patients with ocular injuries than in patients without ocular injuries (22.5% vs. 3.9%, p = 0.004). Among the patients with blunt injuries (N = 118), 69 (58.5%) patients had ocular injuries. These patients had significantly higher proportions of periorbital swelling (89.9% vs. 67.3%, p = 0.002) and diplopia (26.1% vs. 8.2%, p = 0.014) than patients without ocular injuries. Conclusions—In patients with head injuries, concomitant ocular injuries with indications for referral should always be considered. CT serves as a rapid and essential diagnostic tool for the evaluation of concomitant ocular injuries. Ophthalmologists could be selectively consulted for patients with penetrating injuries or specific ocular presentations, thus reducing the burden of ophthalmologists.
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Affiliation(s)
- Chen-Hua Lin
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
- Department of Ophthalmology, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
| | - Xiao Chun Ling
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
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Tang VD, Safi M, Mahavongtrakul A, Mahmood B, Ling J, Kyrillos R, Li J, Mannis M. Ocular Anterior Segment Pathology in the Emergency Department: A 5-Year Study. Eye Contact Lens 2021; 47:203-207. [PMID: 32568931 DOI: 10.1097/icl.0000000000000720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Patients with ocular complaints frequently present to emergency departments (EDs) for care. Emergency department practitioners are often the first to evaluate these patients and determine the next steps in their care, which can be a challenging task. The purpose of this study is to determine the frequency of anterior segment pathology in the setting of the ED in hopes that this information will be useful in creating more effective management algorithms. METHODS A retrospective study based on electronic patient charts from the University of California Davis ED that included ophthalmology consults. We reviewed the charts for demographic data, as well as visual acuity (VA), intraocular pressure (IOP), and diagnosis as determined by ED and ophthalmology personnel, respectively. RESULTS The most common anterior segment diagnoses were uveitis, corneal abrasion, corneal ulcer, meibomian gland dysfunction/dry eyes/blepharitis/punctate epithelial erosions, and conjunctivitis/epidemic keratoconjunctivitis. Emergency Department personnel measured the VA and IOP in 40.8% and 16.7% of patients, respectively. The ophthalmologist measured the VA and IOP in 78.4% and 95.1% of patients, respectively. The percentage agreement in VA measurement between ophthalmology and ED was 11.8%. The percentage agreement in IOP measurement between ophthalmology and ED was 0.86%. The percentage agreement in diagnosis between ophthalmology and ED was 49.4%. CONCLUSIONS Most ocular conditions that present in the ED are nonurgent and can be treated in an outpatient setting. However, ED personnel are often unable to obtain the proper "ocular vital signs" (the VA and IOP) and diagnoses. Our findings suggest a need for clear interprofessional discussion in creating an algorithm for triage and the management of eye conditions in the ED to deliver effective care.
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Affiliation(s)
- Vincent D Tang
- Department of Ophthalmology and Vision Science, UC Davis Eye Center, University of California, Davis, Sacramento, CA
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Franzolin E, Casati S, Albertini O, Antonelli G, Marchetti P, Bonora A, Marchini G. Impact of Covid-19 pandemic on Ophthalmic Emergency Department in an Italian tertiary eye centre. Eur J Ophthalmol 2021; 32:680-687. [PMID: 33631983 DOI: 10.1177/1120672121998223] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the effects of the COVID-19 pandemic on the Ophthalmic Emergency Department (OED) activity of the tertiary eye centre of Verona. METHODS OED reports of patients visited during lockdown (COVID-period) and in the corresponding period of 2017, 2018 and 2019 (COVID-free period) have been retrieved to draw a comparison. Patients' demographic and clinical data recorded and analysed are the following: age, gender, previous ocular history, aetiology, symptoms onset, type of symptoms, discharge diagnosis, urgency and severity of diagnosis. RESULTS OED consultations dropped from 20.6 ± 7.3 visits/day of the COVID-free period to 8.6 ± 4.6 visits/day of the COVID-period. In the COVID-period patients waited longer before physically going to the OED, lamented more vision loss and less redness and reported a higher percentage of traumatic events when compared to the COVID-free period. A significant reduction of ocular surface conditions occurred, while vitreo-retinal disorders increased. Overall, both urgency and severity of diagnosed diseases raised significantly in the COVID-period. CONCLUSION The COVID-19 pandemic drove a significant reduction of the overall OED activity. People with less urgent and milder conditions preferred to wait and endure their ocular discomfort for a few days rather than leaving home and risking to contract the infection. Our analysis highlights how several times the OED is used improperly by patients diagnosed with non-urgent disorders. A more accurate use of the OED would allow a reduction of management costs and the avoidance of overcrowding, which can lead to delays in the care of patients that really need assistance.
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Affiliation(s)
- Elia Franzolin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Casati
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ottavia Albertini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giulio Antonelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Pierpaolo Marchetti
- Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Antonio Bonora
- Department of Emergency and Intensive Care, University Hospital of Verona, Verona, Italy
| | - Giorgio Marchini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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The Study of Incidence and Characteristics of Patients with Eye-Related Chief Complaints at the Emergency Department of Thammasat University Hospital. Emerg Med Int 2020; 2020:4280543. [PMID: 33133696 PMCID: PMC7591951 DOI: 10.1155/2020/4280543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/21/2020] [Accepted: 10/07/2020] [Indexed: 12/19/2022] Open
Abstract
Background Patients with eye-related chief complaints could be diagnosed not only with eye diseases but also with noneye diseases. This study determines rates and characteristics of patients with eye-related chief complaints at the Emergency Department of Thammasat University Hospital. Methods The study design is a descriptive retrospective observational study of patients with eye-related chief complaints at the Emergency Department of Thammasat University Hospital in 2017. Demographic data, diagnosis, management, consultation, and disposition were recorded by chart review. Categorical data were reported by percentage. Results Of the 52081 patients, 704 (1.3%) presented with eye problems. 60% of the patients were males. Patients were classified into three groups which are traumatic eye disease, nontraumatic eye disease, and noneye disease. 75.9% of the patients suffered traumatic injuries. The most common diagnoses of the traumatic eye injuries were foreign bodies at the cornea and conjunctiva and minor trauma to the conjunctiva. The most common mechanisms were foreign bodies in the eyes, cuts, or pierces. The most common causes of the injuries were from metals and housewares. The most common nontraumatic eye diagnoses were conjunctivitis and corneal ulcer. The most common noneye diagnoses were exposure of healthcare providers to secretions from patients, angioedema, and hypertensive crisis. Conclusions Most of the patients who came to the ER with chief complaints of the eyes could be treated by doctors in the emergency room without consulting ophthalmologists. Chief complaints of the eyes could be the leading symptoms of many organ systems. Emergency physicians should be differentially diagnosed to cover neurologic, cardiovascular, and immunologic problems.
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Validation of a new system for triage of ophthalmic emergencies: the alphabetical triage score for ophthalmology (ATSO). Int Ophthalmol 2020; 40:2291-2296. [PMID: 32415656 DOI: 10.1007/s10792-020-01413-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To propose a modified ophthalmic triage system based on simple ophthalmic symptoms, signs and anamnestic data and validate its safety and effectiveness. METHODS Phase 1 of the study was a retrospective review of chart records of patients admitted at the ophthalmic emergencies room (OER); phase 2 was a prospective study conducted on all consecutive patients presenting in the OER between April 1st, 2018, and May 30th, 2018. We selected the following six factors as predictors of urgency levels: altered vision, ocular behavior, color, distress, eye trauma, floaters and flashes. ATSO final score can be eventually converted into risk groups: low-risk group (scoring 0-3), intermediate-risk group (scoring 4-5) and high-risk group (scoring > 6). RESULTS A total of 953 consecutive patients who presented to our OER over a two-month period were considered for participation in the study. The male-to-female ratio was 1.24:1. The mean age of the participants was 53 years (range 18-92, SD 19 years). ATSO score significantly correlated with urgency levels (p < .00001). The sensitivity of ATSO in differentiating urgent from non-urgent conditions was 91.4%, and the specificity was 98.2%. All hospitalized patients (30, 3.15%) have been coded as intermediate/high risk according to the ATSO score. CONCLUSION The use of the ATSO score for patients at the OER provides the clinician with a reliable predictor of urgency, being at the same time safe and effective. The ATSO score may represent a valuable tool to implement triage of ocular patients in the emergency department.
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Eye-related Emergency Department Visits with Ophthalmology Consultation in Taiwan: Visual Acuity as an Indicator of Ocular Emergency. Sci Rep 2020; 10:982. [PMID: 31969635 PMCID: PMC6976571 DOI: 10.1038/s41598-020-57804-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/03/2020] [Indexed: 11/09/2022] Open
Abstract
To investigate the epidemiology of eye-related emergency department (ED) visits and to determine if visual acuity (VA) could be an indicator for determining the timing for managing ocular emergencies, we have conducted the retrospective study which included patients visited the ED for eye-related reasons and had received ophthalmology consultations at a referral center in Taiwan in 2015. Among 46,514 consultations, 5,493 were ophthalmology consultations (11.8%). After exclusion, 5,422 were eligible for analysis. Among them, 1,165 (21.5%) had not likely emergent diagnoses, 4,048 (74.7%) had likely emergent diagnoses, and 209 patients (3.9%) could not be determined. The logMAR VA was 0.31 ± 0.48, 0.66 ± 0.78, and 1.00 ± 0.94 in groups with not likely emergent, likely emergent, and undetermined diagnoses, respectively. Among all eye-related ED visits, 10.3% of patients received ophthalmologic intervention or were admitted to the ophthalmology ward. A LogMAR VA score of 0.45 (decimal equivalent of 0.4) had the highest discrimination power for identifying whether a patient needed ophthalmology intervention or admission to ophthalmology ward (area under the curve: 0.802, sensitivity: 0.800, specificity: 0.672). In our study, we found VA could be an indicator for determining the priority and time of ocular emergencies requiring ophthalmic intervention in patients visiting the ED for eye-related reasons.
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Évaluation du questionnaire de tri infirmier aux urgences ophtalmologiques de l’hôpital Pierre-Paul-Riquet au CHU de Toulouse. J Fr Ophtalmol 2018; 41:708-717. [DOI: 10.1016/j.jfo.2017.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 11/18/2022]
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Rossi T, Boccassini B, Cedrone C, Iossa M, Mutolo M, Lesnoni G, Mutolo P. Testing the Reliability of an Eye-Dedicated Triaging System: The Rescue. Eur J Ophthalmol 2018; 18:445-9. [DOI: 10.1177/112067210801800321] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- T. Rossi
- Ospedale Oftalmico, ASL RM E, Unità Operativa Complessa di Chirurgia Vitreoretinica, Roma
| | - B. Boccassini
- Fondazione G.B. Bietti per lo Studio e la Ricerca in Oftalmologia IRCCS, Roma
| | - C. Cedrone
- Università di Tor Vergata, Dipartimento di Biopatologia e Diagnostica per Immagine, Cattedra di Ottica Fisiopatologica, Roma
| | - M. Iossa
- Ospedale Oftalmico, ASL RM E, Unità Operativa Complessa di Chirurgia Vitreoretinica, Roma
| | - M.G. Mutolo
- Ospedale Oftalmico, ASL RM E, Unità Operativa Complessa di Chirurgia Vitreoretinica, Roma
| | - G. Lesnoni
- Policlinico Città di Pomezia, Unità Operativa di Chirurgia Oculistica, Pomezia (Roma) - Italy
| | - P.A. Mutolo
- Ospedale Oftalmico, ASL RM E, Unità Operativa Complessa di Chirurgia Vitreoretinica, Roma
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AlSamnan MS, Mousa A, Al-Kuwaileet S, AlSuhaibani AH. Triaging self-referred patients attending ophthalmic emergency room. Saudi Med J 2016; 36:678-84. [PMID: 25987109 PMCID: PMC4454901 DOI: 10.15537/smj.2015.6.11302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To introduce an effective and safe ophthalmic triaging system to be used by non-ophthalmologists. Methods: A modified scoring triage system with more relevant clinical symptoms and signs from a previously published Rome Eye Scoring System for Urgency and Emergency (RESCUE) was evaluated over a 2-month period. The study was conducted following a prospective cohort design between March and September 2014 at King Abdulaziz University Hospital, Riyadh, Saudi Arabia. Only self-referred patients were included. Its reliability in differentiating urgent and semi-urgent conditions from non-urgent conditions, identifying patients who need immediate intervention, and decreasing the waiting time were tested using Mann Whitney U test. Results: A total of 531 patients were included in the validation phase to evaluate the triaging system reliability, and 824 patients were included in the implementation phase (applying the system in the ophthalmology emergency room). The sensitivity to differentiate urgent and semi-urgent conditions from non-urgent conditions improved from 90.7 to 98.7%, while the specificity decreased from 97.2 to 87% compared with RESCUE. The sensitivity in differentiating urgent conditions from semi-urgent and non-urgent conditions was 99%, and the specificity was 90%. Mean waiting time reduced from 58.23 minutes to 46 minutes (p=0.014), and the median waiting time reduced from 46 minutes to 33 minutes (p=0.009). Conclusion: This triage system appears to be safe and effective in recognizing the urgency of different ophthalmic conditions, reducing unnecessary ophthalmic emergency load and waiting time significantly.
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Affiliation(s)
- Mazen S AlSamnan
- Division of Ophthalmology, Department of Surgery, Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Sridhar J, Isom RF, Schiffman JC, Ajuria L, Huang LC, Gologorsky D, Banta JT. Utilization of Ophthalmology-Specific Emergency Department Services. Semin Ophthalmol 2016; 33:185-190. [PMID: 27599540 DOI: 10.1080/08820538.2016.1188129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe utilization trends of an ophthalmology-specific emergency department (ED). METHODS Prospective cohort study of new patients presenting in the ophthalmology ED for at least a 30-day period in the spring of each year for five consecutive years (2010-14) at a university referral center. A data form, including information about the ED visit and patient demographics, was included in each patient chart. Data were analyzed with Pearson chi-square test and multiple logistic regression. RESULTS A total of 5323 chart data forms were completed. An average of 42.2 new patients per day presented to the ophthalmology ED. Most common diagnoses were viral conjunctivitis (8.7%), dry eye syndrome (6.6%), and corneal abrasion (6.6%). Non-emergent visits accounted for 35.8% of surveys completed. Factors associated with non-emergent visits included female gender, age 65 years or older, weekday visits, and patient symptom duration greater than one week (p < 0.0001 for each factor). When compared to all other insurance categories combined, patients who were members of the regional public assistance program were the most likely to present with a non-emergency (48.5% versus 34.9%, p < 0.001), while Workers' Compensation patients were least likely to present with a non-emergency (16% versus 36.5%, p < 0.001). CONCLUSIONS Over one-third of new patient visits were non-emergent. Factors predictive of non-emergent patient visits were female gender, age 65 years or older, duration of symptoms greater than one week, weekday visits, and the form of insurance coverage.
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Affiliation(s)
- Jayanth Sridhar
- a Department of Ophthalmology , Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Ryan F Isom
- a Department of Ophthalmology , Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Joyce C Schiffman
- a Department of Ophthalmology , Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Luz Ajuria
- a Department of Ophthalmology , Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Laura C Huang
- a Department of Ophthalmology , Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Daniel Gologorsky
- a Department of Ophthalmology , Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - James T Banta
- a Department of Ophthalmology , Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
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Consensus on Severity for Ocular Emergency: The BAsic SEverity Score for Common OculaR Emergencies [BaSe SCOrE]. J Ophthalmol 2015; 2015:576983. [PMID: 26294965 PMCID: PMC4534620 DOI: 10.1155/2015/576983] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022] Open
Abstract
Purpose. To weigh ocular emergency events according to their severity. Methods. A group of ophthalmologists and researchers rated the severity of 86 common ocular emergencies using a Delphi consensus method. The ratings were attributed on a 7-point scale throughout a first-round survey. Then, the experts were provided with the median and quartiles of the ratings of each item to reevaluate the severity levels being aware of the group's first-round responses. The final severity rating for each item corresponded to the median rating provided by the last Delphi round. Results. We invited 398 experts, and 80 (20%) of them, from 18 different countries, agreed to participate. A consensus was reached in the second round, completed by 24 experts (43%). The severity ranged from subconjunctival hemorrhages (median = 1, Q1 = 0; Q3 = 1) to penetrating eye injuries collapsing the eyeball with intraocular foreign body or panophthalmitis with infection following surgery (median = 5, Q1 = 5; Q3 = 6). The ratings did not differ according to the practice of the experts. Conclusion. These ratings could be used to assess the severity of ocular emergency events, to serve in composite algorithms for emergency triage and standardizing research in ocular emergencies.
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