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Dolly A. Padovani-Claudio, Nidhi Talwar, Paul P. Lee, Joshua D. Stein; Characteristics of Patients Presenting to the Emergency Department with Sight-Threatening Ocular Conditions. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6937.
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To determine patient characteristics associated with emergency department (ED) use for sight-threatening ocular conditions.
Using claims data from a managed-care network, all adults aged ≥21 with an eye-related ED visit in 2001-2009 were identified. Using ICD-9-CM billing codes, we identified patients who received a sight-threatening ocular diagnosis (e.g., endophthalmitis, orbital cellulitis/hemorrhage, giant cell arteritis, ruptured globe, acute angle closure glaucoma), but no nonocular diagnoses, during an ED visit. Multivariable Cox regression was performed to assess the patient characteristics associated with seeking ED care for a sight-threatening ocular condition.
Among the 107568 enrollees with an ED visit for any ocular condition, 9237 (8.6%) received a diagnosis of a potentially sight-threatening condition. Compared with non-Hispanic whites, Latinos had a 30%-increased hazard of presenting to the ED for a sight-threatening ocular condition (HR=1.30 [CI=1.01-1.66]). Women had a 22%-decreased hazard of urgent ED eye care (HR=0.78 [CI 0.68-0.89]). Compared to urban residents, rural residents had a 45%decreased hazard of presenting to the ED for an urgent eye problem (HR=0.55 [CI=0.33-0.92]). Individuals with household net worth levels of $150-500K had a 27%-decreased (HR=0.73 [CI=0.58-0.91]) hazard of presenting to the ED with an urgent ocular problem when compared to persons with net worth levels <$25K. For every additional year of age, the hazard of presenting to the ED for an urgent eye problem decreased by 1% (HR=0.99 [CI=0.98-0.99]). Those in Medicaid and Medicare managed-care plans had a 124%- and 69%-increased hazard, respectively, of presenting with an urgent ocular condition, relative to those in commercial plans (HR=2.24 [CI=1.27-3.42] and HR=1.69 [CI=1.23-2.32]). Enrollees with frequent ED use for nonophthalmologic conditions (≥3 visits/yr) had a 179%-increased hazard of visiting the ED for an urgent eye condition.
Younger age, male sex, Latino ethnicity, lower income level, and urban residence were associated with presentation to the ED with sight-threatening ocular conditions. Efforts focused on preventing ocular injuries among individuals with these sociodemographic characteristics and persons residing in these communities may reduce both ED use and vision loss.
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