Abstract
Abstract: :
Purpose: To assess the pattern and accuracy of ocular disease diagnosis and management by emergency department (ED) physicians. Methods: A retrospective, noncomparative case series was performed. Non–consecutive patients presenting to the ED at the John H. Stroger, Jr. Hospital of Cook County (CCH), Chicago, Illinois with any ocular complaints between January and November of 2003 were evaluated. Only those patients referred for follow up in the ophthalmology department at CCH were included. A standardized intake form was used. Results: One hundred patients were included. The average age was 39.4 years (range 6–77 yrs), and the gender was 65M/35F. The etiology of confirmed ophthalmic diagnoses was as follows: 47 inflammation/infection (conjunctivitis, uveitis, blepharitis, etc.), 28 trauma (orbital fractures, corneal foreign bodies, traumatic iritis, etc.) and 24 other (all other diagnoses). ED physicians made a correct diagnosis in 38 cases (38%). ED physicians administered appropriate treatment in 45 cases (45%). Of the one hundred cases, 44 (44%) were determined to be vision threatening by ophthalmologists. Vision threatening diagnoses in this subset of patients included infectious keratitis, corneal ulcers, uveitis, retinal detachments, retinal vascular disorders, penetrating or perforating eye injuries, traumatic iritis and acute glaucomas. ED physicians made a correct diagnosis in 12 of 44 vision threatening cases (27.2%). Appropriate management in vision threatening cases was administered in 14 of 44 cases (31.8%). In only 9 of 44 (20.5%) vision–threatening cases did ED staff consult an on–call ophthalmologist at the time of initial presentation. However, all patients were referred to the eye clinic for follow–up. Conclusions: The most common ocular presentations to the ED in our study were inflammation/infection followed by trauma. While the majority of these were not urgent or emergent problems, 44% were determined to be vision–threatening conditions when reviewed by ophthalmology staff. In the majority of vision threatening cases the diagnosis and management was not appropriate, and ophthalmology was consulted in only a minority of these cases. The limitations of our study include retrospective design, small sample size, non–consecutive patient enrollment, and possible enrollment bias. Our findings may suggest a need for both greater exposure of ED physicians to ophthalmic care guidelines as well as improved communication between ED physicians and ophthalmologists.
Keywords: clinical (human) or epidemiologic studies: outcomes/complications • clinical (human) or epidemiologic studies: health care delivery/economics/manpower • clinical (human) or epidemiologic studies: biostatistics/epidemiology methodology