Comparing the subjective and the objective severity of affections observed at emergency room in ophthalmology

Abstract

Purpose: The triage process at ophthalmological emergencies (OER) evaluates the severity of ocular conditions. However, the concept of severity is imprecise, and differently approached. We compared the subjective severity perceived by patients and the objective evaluation of severity provided by physicians. A pilot study conducted retrospectively over 6 months on 3003 patients revealed that patients tended underestimating the severity of their affection. We aimed to investigate that discrepancy prospectively.

Methods: Both patients and physicians were enrolled to quantify the severity of the ocular condition referred to OER over two months (July and October 2013). A nurse collected patient’s subjective score of ocular condition severity from 0 (no severity) to 6 (maximal) and graded patient’s behavior from 0 (normal) to 5 (violent or highly incoherent). After examination, the ophthalmologist provided an objective severity score for the same ocular condition. Data were analyzed prospectively and anonymously.

Results: We collected 4478 forms of which 78 % were correctly completed both by the nurse and the physician (n=3486). The average age of the patients was 43.58 years (43.02 to 44.14; IC 95%). Half of the patients displayed a normal behavior (score 0; n=2227). The mean behavior score was 0.553. Only one patient scored 5. The severity couldn't be scored by 755 patients (17%). Patients scored severity as none, minor, moderate, serious, severe, critical or maximal in 682, 1296, 1018, 530, 111, 16, and 4 cases, and by ophthalmologists in 1553, 624, 1159, 634, 296, 87 and 47 cases, respectively. The severity was scored identically both by the ophthalmologist and the patient in 20 % of the cases (293, 180, 299, 86, 19, 2 and 0 cases respectively). The subjective score was lower than the objective for 300 patients and higher for 75 patients .

Conclusions: The trend of the pilot study is prospectively confirmed .The severity of ocular affections seen at OER is differently scored by patients or by ophthalmologists, and tend to be underestimated by patients. Half of the patients modified their behavior due to their ocular condition.

Keywords: 460 clinical (human) or epidemiologic studies: health care delivery/economics/manpower • 462 clinical (human) or epidemiologic studies: outcomes/complications • 742 trauma