June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Differences in acute chemical injury severity grading between Cornea specialists and non-Corneal specialists
Author Affiliations & Notes
  • Francisco C Figueiredo
    Ophthalmology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Newcastle upon Tyne, United Kingdom
    Biosciences Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom
  • Boon Lin Teh
    Ophthalmology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Newcastle upon Tyne, United Kingdom
  • Michael Shaw
    Ophthalmology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Newcastle upon Tyne, United Kingdom
  • Jaswant sandhu
    Ophthalmology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Newcastle upon Tyne, United Kingdom
  • Footnotes
    Commercial Relationships   Francisco Figueiredo None; Boon Teh None; Michael Shaw None; Jaswant sandhu None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 3976 – A0256. doi:
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      Francisco C Figueiredo, Boon Lin Teh, Michael Shaw, Jaswant sandhu; Differences in acute chemical injury severity grading between Cornea specialists and non-Corneal specialists. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3976 – A0256.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Ocular chemical injuries (OCI) require prompt medical attention, including immediate assessment with appropriate treatment, as they are potentially blinding. Severity grading assessment of OCI on presentation is important both for management and prognosis.
This study aimed to look at inter-rater reliability between Cornea specialists and non-Corneal specialists in grading acute chemical injury severity.

Methods : This is a prospective study in a United Kingdom (UK) tertiary hospital in two different time periods: September 2017–June 2018 and September 2021–December 2021.
Consecutive patients presenting to the Eye Emergency Department (EED) with a history of acute OCI within those two time periods were included. Patients were initially assessed by non-Corneal specialists of different grades (specialty trainee to consultant) using Roper-Hall classification, with treatment initiated as per local protocol. They were then assessed by Cornea specialists within 24 hours of presentation to compare the chemical injury severity grading.

Results : Forty eyes of 31 patients had acute OCI. Most of the patients were male (77%; n=24) with mean age of 42 (range:19-84; SD:18). The majority (55%; n=17) had alkali injuries and 65% (n=20) of them were accidents at workplace or home.
Thirty-five eyes (87%) had a mild chemical injury (Grade 1 and 2) and carried a good prognosis. Seven eyes with mild chemical injury and four eyes with moderate-severe chemical injury of Grade 3 and 4 were due to assault.
There was a 70% (n=28 eyes) agreement between Cornea specialists and non-Corneal specialists. The remaining 10% (n=4 eyes) were under-graded and 20% (n=8 eyes) were over-graded. Of those under-graded eyes, there was no change in management in 3 eyes, including two which required perilimbal conjunctiva resection and human amniotic membrane transplant. One had additional topical therapy and had a full recovery.
For the over-graded eyes, six eyes had their topical therapy regime simplified. Two eyes were admitted to hospital for treatment and discharged earlier following re-grading of the injury.

Conclusions : There is good inter-rater reliability between Cornea specialists and non-Corneal specialists in grading OCI severity. Over-grading may increase treatment cost with avoidable admission whilst under-grading may compromise patient care. Further data collection is needed to allow for two comparable time period.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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