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Brett P Bielory, Jonathan Jacobs, Tad Wandel, Dawn Rush, Kenneth Juechter; Emergency Department and Inpatient Pediatric Ophthalmology Consults at a Tertiary Care Children’s Hospital. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2435.
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Pediatric ophthalmologic consultations in both the emergency department (ED) and inpatient pediatric populations are continuously requested for evaluation of a variety of conditions at a tertiary care center. Our study goals were set to review and compare: the reasons for the consult, the medical diagnosis, and the final ophthalmic diagnosis between inpatient and ED consultations at a tertiary care children's hospital.
Health Records on ED and inpatient floor consults were evaluated by the ophthalmology service between July 2014 and June 2015 were retrospectively reviewed. Variables including reason for consult, ophthalmic diagnosis, and ophthalmic intervention were recorded in both groups. A two-sample test was used to compare ED patients to floor patient consults seen at Westchester Medical Center. P-values < 0.05 are considered significant.
261 consults were reviewed. 110 (42.1%) new pediatric ED and 151 (57.8%) new pediatric inpatient consults were requested. Stratification revealed: 46 patients on the pediatrics floor (17.6%), 44 patients in the Neonatal ICU (16.8%), and 31 patients in Pediatric ICU (11.8%). Common reasons for consultation in the ED were eye pain (19.1%), periorbital swelling (11.8%), and rule-out papilledema (9.1%). Common reasons for consultation on the floor were rule-out chorioretinitis (17.4%), rule-out papilledema (13.1%), and rule-out non-accidental injury (8.3%).The most common ophthalmic diagnoses in the ED were corneal abrasion (8.1%), papilledema (7.2%), and orbital cellulitis (6.3%). The most common ophthalmic diagnoses on the floor were orbital cellulitis (6.5%), papilledema (4.3%), and peri-orbital cellulitis (4.3%). The most common ophthalmic diagnoses in the Neonatal ICU were cataract (4.5%), bacterial conjunctivitis (4.5%), and optic nerve hypoplasia (4.5%). The most common ophthalmic diagnoses in the pediatric ICU were orbital fracture (9.6%) and papilledema (6.5%). 28.1% and 65.2% of ED and floor patients, respectively, had a normal ocular exam, p< 0.05.
Our results demonstrate the characteristics of a robust ED and inpatient service at pediatric tertiary trauma care center. Physicians at teaching hospitals can incorporate this data to optimize patient care and to improve the training curriculum from ophthalmology and non-ophthalmology house-staff.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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