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Russell Russell Day, Mark P Breazzano, Uyen L Tran; Pre- and post-intervention study of corneal chemical burns: exclusive implementation of broad spectrum pH strips. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2317.
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© ARVO (1962-2015); The Authors (2016-present)
Corneal chemical burns are ophthalmic emergencies that may lead to irreversible blindness. While precise evaluation and prompt irrigation is standard practice for eyes with alkaline or acidic burns, it is unknown to what extent specific pH measurements influence clinical management. Vanderbilt University Medical Center replaced its nitralazine strips (pH 1-7.5) exclusively with broad spectrum strips (pH 1-13) by October 1, 2016 as part of a quality improvement intervention to ensure consistent and accurate alkalinity detection. We hypothesize that broad spectrum strips lead to more accurate pH measurement and expedited ophthalmologic consultation in the setting of emergent corneal chemical burns.
All emergent adult ophthalmology consultations at Vanderbilt University Medical for chemical burns were included in a pre-intervention (n= 22; between October 1, 2015 and September 30, 2016) and post-intervention (n=19; October 1, 2016 to October 31, 2017) study design. Causative chemical agent, time interval from emergency department triage to ophthalmology consultation, and ocular surface pH values obtained by consulting and ophthalmology staff were recorded and analyzed.
Most burns were caused by alkaline chemicals, both pre- and post-intervention. The average time from emergent triage to ophthalmology consultation decreased significantly from 83 minutes pre-intervention to 42 minutes post-intervention (p=0.04, simple t-test). Among 13 pre-intervention consultations with sufficient data, 4 (31%) demonstrated higher ocular pH values by ophthalmology staff upon initial evaluation compared to consulting staff, while all 16 post-intervention consultations with adequate data showed congruity of initial pH measurements between consulting and ophthalmology staff (p=0.03, Fisher’s exact test).
The exclusive implementation of broad spectrum pH strips may allow for greater accuracy in chemical burn diagnosis, and hasten clinical management of ocular chemical burns with faster ophthalmology consultation times. Availability of nitralazine strips and similarly narrow spectrum pH strips may be dangerous in the clinical setting by falsely reassuring the examiner with inherently inaccurate alkalinity readings.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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