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Neil Vyas, John Gittinger; Incidence and frequency of positive findings in inpatient ophthalmology consultations at Boston Medical Center. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6105.
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Boston Medical Center (BMC) is a busy Level -1 trauma and tertiary care center in New England. It is also the “safety net” hospital for low income, underinsured, and uninsured patients in Massachusetts. Given the high volume of admitted patients, the inpatient ophthalmology consult service is quite busy. We evaluate the types of inpatient ophthalmology consultations and what interventions, if any, were performed as a result of the consultation.
Retrospective chart review of consecutive inpatient ophthalmology consultations at BMC, including those originating from the emergency room who were being admitted, over a 3 month period from October-December 2012 with no exclusion criteria. Reason for consultation, ophthalmologic findings, and any new interventions or changes in overall treatment plan were recorded.
106 patients were evaluated. The most common reason for consultation was orbital bone fracture (23/106). None required acute intervention. Consultation status post neurosurgical intervention was also common (7/106) with no changes in neurosurgical plan based on eye findings. Of patients with subjective blurry vision or discomfort without known ocular diagnoses, dry eye was the most common etiology (7/12). In AIDS patients with low CD4 counts <50, 4/12 had positive intraocular findings. All patients with transient monocular vision loss with full visual recovery (4/4) had normal exams. All patients with systemic candidemia were negative for fungal endophthalmitis (6/6).
For two of the most common reasons for ophthalmology inpatient consultation—orbital fracture and post neuro-surgical intervention—no acute intervention was required. In addition, in patients with new blurry vision and discomfort without prior ophthalmologic co-morbidities, especially in those with long hospital stays, dry eye was most often the culprit. In contrast, there was a relatively high incidence of positive findings in patients with immunosuppression secondary to AIDS. In a busy hospital setting, effective triage of patients is often necessary. This study may provide a positive predictive value on which patients may have ophthalmologic findings based on initial reason for consultation and may also help primary teams begin empiric therapy on patients prior to ophthalmologic consultation (such as artificial tears) to help resolve patient discomfort more rapidly.
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