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Jason Dettori, Parisa Taravati; Diagnostic Accuracy Of Emergency Medicine Provider Eye Exam. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1434.
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It is common for patients to go to the emergency room (ER) after having an eye injury. However, many patients seek care at an emergency room for other non-injury related eye problems. Since there is a trend toward an increasing number of patients presenting to the ER for various eye conditions and a decreasing number of ophthalmologists who take emergency call, the diagnostic accuracy of an ER provider’s eye exam will become increasingly important in evaluating and treating these patients. The purpose of this study was to determine the accuracy of the ER provider eye exam in an academic hospital.
A retrospective review was performed of all patients seen in the University of Washington Medical Center ER who were subsequently referred to the Ophthalmology Clinic from October 1, 2009, to January 1, 2011. Only patients who were evaluated in the Ophthalmology Clinic within 24 hours of the ER evaluation were included in the study. These charts were reviewed to determine: 1. Whether an appropriate history was taken by the ER provider (i.e. physician, nurse practitioner, or physician assistant); 2. The accuracy of the ER provider’s exam findings in comparison to that of the ophthalmologist; and 3. The accuracy of the ER provider’s diagnosis compared to that of the ophthalmologist.
Of the 142 patients who were seen by the ER and then referred to the Ophthalmology clinic, 45 patients met our eligibility criteria and were included in the study. A pertinent history was taken by the ER provider 71% of the time. The visual acuity was checked by the ER 66% of the time, with only 47% agreement with the ophthalmologist’s exam. The pupil exam (reactivity and size) was performed by the ER 78% of the time with 71% agreement. The presence or absence of a relative afferent pupillary defect was never checked by the ER. Confrontation visual fields were checked by the ER 11% of the time and agreed 80% of the time. Ocular motility was assessed by the ER 62% of the time and agreed 83% of the time. Intraocular pressure was measured by the ER 13% of the time and agreed 60% of the time. The anterior segment exam was performed by the ER 78% of the time and agreed 54% of the time. A diagnosis was made the by ER 91% of the time and agreed 59% of the time. A plan was formulated by the ER 56% of the time and agreed 40% of the time. Commonly missed diagnoses by the ER were related to anterior segment pathology, with dry eye being most commonly missed diagnosis.
Emergency room provider eye exams at this institution may benefit from focused exam instruction and teaching. In the future, we will plan on incorporating ER data from the Harborview Medical Center (also affiliated with the University of Washington), as well as other academic centers.
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