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Jason Mayer, Zachary Landis, Ming Wang, Ingrid U Scott; Characteristics of Inpatient Ophthalmology Consults Associated with Ocular Pathology and Need for Ophthalmologic Intervention. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5554.
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To identify, among inpatient ophthalmology consults, clinical examination findings predictive of ocular pathology and need for ophthalmologic intervention
The medical records of patients evaluated by the ophthalmology consultation service at Penn State Hershey Medical Center between 9/1/2012 and 8/31/2013 were reviewed. Consults for retinopathy of prematurity and non-accidental trauma were excluded. Data collected include demographic characteristics, reason for consult, ophthalmology exam findings, primary/secondary ophthalmic diagnoses, procedure/intervention performed as a result of the consult, length of hospitalization prior to consult, and duration of hospitalization. Data were analyzed to investigate associations between exam findings (specifically visual acuity, pupil and extraocular muscle [EOM] exam) and the presence of ocular pathology and need for intervention.
To date, data have been collected from 173 patients. The study population includes 96 (55.5%) men and the mean patient age is 40 years. Decreased vision (30.0%) was the most common reason for consultation followed by “rule out ocular/orbital trauma” (24.3%) and eye pain (8.7%). Services requesting the most consults were trauma (17.9%), pediatrics (15.0%) and medicine (13.3%). The most common primary ophthalmic diagnoses were orbital fracture (15.6%), normal ocular exam (12.1%) and fungal endophthalmitis ruled out (7.5%). Forty-three percent of consults resulted in no intervention, while the most common interventions were outpatient follow-up (23.1%), medication (20.8%) and further imaging (8.1%). Abnormalities on pupil exam and decreased visual acuity (defined as 20/40 or worse as measured with a near card) were significant predictors of the need for intervention (p=0.005 and p=0.03, respectively). Abnormal EOM exam was not a significant predictor of the need for intervention (p=0.47).
Ophthalmological inpatient consultation makes a significant difference in the care of hospitalized patients, with over half of ophthalmology consults resulting in interventions such as medications, further imaging/labwork, or surgery. For busy inpatient consult services, visual acuity and pupil exam findings communicated to the ophthalmology service by the primary team can help triage how likely a patient is to need intervention and how urgently a patient needs to be evaluated.
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