Abstract
Purpose :
Limited outcome and descriptive data exist regarding ocular complaints that presents to Emergency Departments (ED) within the United States. We performed a retrospective review of ophthalmology consults at two level-one trauma centers in Colorado to identify trends for ophthalmic consultation and factors associated with urgent and emergent pathology.
Methods :
This study consisted of a retrospective chart review of ED consults to the ophthalmology service that occurred between Feb 25th, 2016 and Feb 25th, 2018. Characteristics such as patient age, sex, race/ethnicity, illicit drug use, and medical insurance status were recorded. Encounter measures included chief complaint, diagnostic steps, diagnosis at the ED, timeframe to follow-up, final ophthalmologic diagnosis as well as intervention and disposition. We categorized consultations into three groups depending on the final ophthalmic diagnosis: emergent, urgent, and non-emergent. Emergent diagnoses were defined as those requiring a procedure or surgery during the encounter. Urgent diagnoses were pre-defined conditions that required prompt treatment such as uveitis, orbital fracture, and corneal ulcer among others. Non-urgent diagnoses did not require further treatment or intervention.
Results :
A total of 695 charts were identified, 288 at the University of Colorado Hospital and 407 at Denver Health Medical Center. Females comprised 247 (35.5%) of the encounters. The average age at presentation to the ED was 42 years old. Most ED visits were emergent, 53.7%, followed by non-urgent, 29.8%, and 15.8% were urgent. Only 465 (67.5%) of all visits had a visual acuity checked. Males were significantly more likely to present with trauma (33.9% vs 15.4%, p<0.0001) and more likely to have emergent or urgent diagnoses (67.0% and 75.4% male, p=0.0001) compared to females. Of the 473 patients that were discharged from the ED with ophthalmology follow-up, only 283 (59.8%) were seen within 30 days of their initial presentation.
Conclusions :
Ophthalmology consultation analyses in the emergency room allow us to identify areas for improvement in care of our patients related to urgent complaints. Inconsistency of initial ED exams may account for high numbers of unnecessary ophthalmology consultations. More information is needed to understand why there is poor ophthalmology follow-up after ED consultations.
This is a 2021 ARVO Annual Meeting abstract.