Purpose:
To assess the pattern and accuracy of ocular disease diagnosis and management in an emergency department (ED) in a U.S. Level 1 Trauma Center.
Methods:
We conducted a prospective study of consecutive patients presenting to the ED at the John H. Stroger, Jr. Hospital of Cook County (CCH), Chicago, Illinois with any ocular complaints from September 2011 through November 2011. A standardized intake form was used to gather demographic, diagnostic and management data on each patient. Only those patients referred to the eye clinic at CCH for follow-up and subsequently evaluated by an ophthalmologist were included in the study.
Results:
The total number of patients included in the study was 61, of which 54 had records that were complete for evaluation. The most common ocular disease categories presenting to our ED were posterior segment, trauma, and inflammation/ infection. This finding is consistent with prior studies and expected given our urban setting. Emergency department physicians made a correct diagnosis in 65% (35) of total cases and recommended appropriate treatment in 76% (41). After ophthalmology assessment, 52% (28) of the diagnoses were deemed vision threatening and 48%(26) non-vision threatening. A correct diagnosis was less common in non-vision threatening cases 58% (15) compared to vision threatening cases 68% (19). However, a concerning finding was that patients with vision threatening conditions were less likely to receive appropriate treatment 64% (18) than those with non-vision threatening conditions 81% (21). Ophthalmology was not consulted emergently (24 hours or less) in 27% (5) of cases ultimately determined to be vision threatening.
Conclusions:
Our study suggests a need for improved ED physician exposure to current ophthalmic practice guidelines and communication with ophthalmologists. A larger, multi-center study is needed to assess the ophthalmic diagnostic accuracy of ED physicians. We plan to continue this study for 1 year and present the results at an interdisciplinary conference with ED physicians and ophthalmologists at our institution. We hope to identify specific areas for further ED physician education and ultimately help improve the delivery of patient care.
Keywords: clinical (human) or epidemiologic studies: systems/equipment/techniques • clinical (human) or epidemiologic studies: health care delivery/economics/manpower • clinical (human) or epidemiologic studies: outcomes/complications