Objective and subjective severity of affections observed at emergency room in ophthalmology

Abstract

Purpose: The severity of ocular affections is critical to the triage process at ophthalmological emergencies (OER). However, the concept of severity is broad and vague concept, and might be differently approached by physicians and patients. We investigated ocular affection presenting at emergencies. We compared the subjective severity perceived by patients and the objective evaluation of physicians.

Methods: Both patients and physicians were enrolled to quantify the severity of the ocular affection justifying the visit at ophthalmological emergencies. We deliberately did not define severity. From the 1st January to the 31st of November 2012, a nurse collected from patients the subjective severity on a scale graded from 0 (no severity) to 5 (maximal) and graded patient’s behavior from 0 (normal) to 5 (violent or highly incoherent). After ophthalmological examination, the physician had to quantify objective severity from 0 to 5. Data were analyzed prospectively and anonymously.

Results: A total of 3003 forms were collected. Two third of the patients displayed a normal behavior (score 0; score 2000). The mean behavior score was 0.375, while only one patient scored 5. No severity score could be obtained from 241 patients (8%). Severity was considered by patients as none, minor, moderate, serious, severe or maximal in 1011, 827, 491, 363, 59 and 11 cases, and by ophthalmologists in 687, 575, 894, 498, 218 and 131 cases, respectively. Severity was identically scored both by the ophthalmologist and the patient in a fifth of the cases (230, 151, 128, 55, 7 and 0 respectively). The score for severity was underestimated (score 0 to 3 vs 4 to 5) by 280 patients and overestimated (4 to 5 vs 0 to 3) by 52 patients. No statistical correlation was found between patient’s behavior and subjective severity although a third of the patients displayed abnormal behaviors.

Conclusions: The severity of an ocular affection seem at OER is scored differently by patients and by ophthalmologists. It seems to be more often underestimated by patients. A third of the patients seen at OER considered their behavior to be modified by the affection.

Keywords: 459 clinical (human) or epidemiologic studies: biostatistics/epidemiology methodology