Factors Affecting Visits to the Emergency Department for Urgent and Nonurgent Ocular Conditions

Stagg, Brian C.; Shah, Muazzum M.; Talwar, Nidhi; Padovani-Claudio, Dolly Ann; Woodward, Maria A.; Stein, Joshua D.

doi:10.1016/j.ophtha.2016.12.039

Cited by 57 publications

(71 citation statements)

References 33 publications

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“…While previous research has described the epidemiology of CCI in hospital‐based emergency departments, this is the first time this issue has been addressed at community based UCC. In this study, an injury to the cornea and/or conjunctiva was present in 0.8% of patients who presented to Urgent Care Centres (UCC) with about half of them presenting with a foreign body in the eye.…”

Section: Discussionmentioning

confidence: 99%

“…In the USA 1.5% of all emergency department (ED) visits had an ophthalmic principal diagnosis, of which ~21% were due to corneal injury . Several studies have found that between 23% and 44.4% of ocular injury cases in the ED were not an emergency and could have potentially been managed outside the ED . Management of these cases outside the ED could make ED resources more available for emergency ophthalmic and medical issues …”

Section: Introductionmentioning

confidence: 99%

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Corneal and conjunctival injury seen in urgent care centres in Israel

Zimmerman

Shneor

Millodot

et al. 2019

Ophthalmic Physiologic Optic

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PurposeCorneal and conjunctival injuries (CCI) comprise a large portion of the cases presenting to hospital‐based emergency departments (ED) with ocular involvement. Urgent Care Centres (UCC) offer community based emergency care at lower cost than hospital‐based emergency departments (ED) and with greater temporal convenience than primary care office settings. While CCI prevalence and treatment at hospital‐based EDs has been well studied, this is the first report, to our knowledge, on CCI demographics and aetiology presenting to UCCs.MethodsThis retrospective study was approved by the institutional ethics committee. The setting is a UCC system in Israel, modelled on USA urgent care facilities, consisting of 17 branches at the time of the study. Electronic medical record data (between November 1, 2015 and October 31, 2016) of patients diagnosed with corneal disorder, foreign body or eye disorder were retrieved and reviewed for inclusion/exclusion criteria. Data collected included gender, age, chief complaint, diagnosis, treatment and discharge status (sent home or referred to ED). International Classification of Diseases, Ninth Revision (ICD‐9) codes were assigned to each record based on a review of all fields. UCC results were compared to all ED patients in Israel using data from a public report. Data were analysed by descriptive statistics and logistic regression analysis.ResultsOf the 602 074 charts screened, 4797 patients presented with CCI (0.8%). The average age was 32.6 ± 18.2 years and 71.3% were male. Among these, 26.4% were referred to the ED compared to 6.8% from the entire UCC cohort. ICD‐9 code Foreign body (FB) of the eye was the most common cause of CCI (56.5%) followed by the following ICD‐9 codes: trauma (18.1%), chemical in the eye (11.1%) and corneal disorder due to a contact lens (5.1%). Logistic regression analyses showed the following risk factors for ED referral: age (22–64), male gender, ICD‐9 code FB, work‐related injury and the presence of a clinical abrasion in the eye.ConclusionsThe aetiology of ocular injury at UCC is similar to previous studies of ED. Most CCI can be treated at UCC saving ED resources and underscores the importance of this mode of health care delivery in the overall health system.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Corneal and conjunctival injury seen in urgent care centres in Israel

Zimmerman

Shneor

Millodot

et al. 2019

Ophthalmic Physiologic Optic

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“…6,7,18–22 In much of the United States, when people develop eye and vision problems, they go to primary care providers or emergency departments. 6,15,18,23,24 Constraints for optimal care from primary care providers include the lack of ophthalmic expertise, insufficient time, and inadequate referral systems. The National Eye Institute (NEI) states that corneal diseases cause the majority of visits for eye care.…”

Section: Introductionmentioning

confidence: 99%

Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability

Woodward

Musch

Hood

et al. 2017

Cornea

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Purpose Corneal and anterior segment diseases cause the majority of urgent visits to eye-care professionals. We evaluated the diagnostic accuracy of detecting corneal diseases using external photographs from two portable cameras for telemedicine purposes. Methods A prospective study of adults with a clinical diagnosis of corneal pathology including corneal abrasions, ulcers, scars, and pterygia. A corneal specialist provided the gold-standard diagnosis by slit-lamp examination. Images of both eyes were obtained using iTouch 5S and Nidek VersaCam cameras in multiple gazes and interpreted by 3 cornea specialists for presence of pathology. Accuracy to detect disease was compared to gold standard diagnosis, stratified by camera and grader. Reliability was evaluated with weighted kappa statistics. Graders assessed image quality on a Likert scale from 1 (poor) to 9 (optimal). Results 198 eyes (110 subjects) were photographed. By gold standard diagnosis, 59 eyes (30%) had corneal scars, 34 (17%) had ulcers, 13 (7%) had abrasions, 10 (5%) had pterygia, and 82 (41%) were normal. Sensitivity to detect AS pathology ranged from 54–71% for iTouch and 66–75% for Nidek, across graders; specificity ranged from 82–96% for iTouch and 91–98% for Nidek. Inter-grader reliability was moderate to strong (kappa ranges: 0.54–0.71 for iTouch; 0.75–0.76 for Nidek. Quality ratings were variable between graders. Conclusions External photographs taken by standard, non-enhanced portable cameras and interpreted remotely by ophthalmologist graders yielded sensitivity values that are not yet suitable for telemedicine applications. Additional work is needed to improve the ability to detect AS pathology remotely.

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“…Ocular complaints are common emergency department (ED) presentations, accounting for approximately 3.4% of all ED visits over a 5‐year period . The differential diagnosis of flashes and floaters includes posterior vitreous detachment, retinal detachment, posterior uveitis, vitreous hemorrhage, oculodigital stimulation, rapid eye movements, neovascular age‐related macular degeneration, migraine with aura, occipital lobe disorders, and postural hypotension .…”

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confidence: 99%

Point‐of‐Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta‐Analysis

Gottlieb

Holladay

Peksa

2019

Academic Emergency Medicine

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Background: Ocular complaints are common presentations to the emergency department (ED). Among these, retinal detachment can cause significant vision loss if not rapidly diagnosed and referred for appropriate treatment. Point-of-care ultrasound has been suggested to identify the diagnosis rapidly when the ocular examination is limited or the ophthalmology service is not readily available. However, prior studies were limited by small sample sizes, resulting in wide ranges of potential accuracy. The primary outcome for this review was to determine the test characteristics of point-of-care ocular ultrasound for the diagnosis of retinal detachment.Methods: PubMed, CINAHL, Scopus, LILACS, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and bibliographies of selected articles were assessed for all prospective and randomized controlled trials assessing the accuracy of point-of-care ultrasound for identifying retinal detachment. Data were dual extracted into a predefined worksheet and quality analysis was performed using the QUADAS-2 tool. Data were summarized and a meta-analysis was performed with planned subgroup analyses by location and provider specialty. This review was registered with PROSPERO CRD42018097288. There was no funding for this review.Results: Eleven studies (n = 844 patients) were identified. Overall, ultrasound was 94.2% (95% confidence interval [CI] = 78.4% to 98.6%) sensitive and 96.3% (95% CI = 89.2% to 98.8%) specific for the diagnosis of retinal detachment with a positive likelihood ratio of 25.2 (95% CI = 8.1 to 78.0) and a negative likelihood ratio of 0.06 (95% CI = 0.01 to 0.25). Subgroup analysis found that ultrasound was more accurate among ED patients, but was not significantly different when performed by ED or non-ED providers.Conclusions: Point-of-care ocular ultrasound is sensitive and specific for the diagnosis of retinal detachment.Future studies should determine the ideal training protocol and the influence of color Doppler and contrastenhanced ultrasound on diagnostic accuracy. O cular complaints are common emergency department (ED) presentations, accounting for approximately 3.4% of all ED visits over a 5-year period. 1 The differential diagnosis of flashes and floaters includes posterior vitreous detachment, retinal detachment, posterior uveitis, vitreous hemorrhage, oculodigital stimulation, rapid eye movements, neovascular age-related macular degeneration, migraine with aura, occipital lobe disorders, and postural hypotension. 2 While most patients will have a benign etiology, up to 10% to 26% of patients presenting with acute onset of flashes or floaters will be diagnosed with a

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Factors Affecting Visits to the Emergency Department for Urgent and Nonurgent Ocular Conditions

Cited by 57 publications

References 33 publications

Corneal and conjunctival injury seen in urgent care centres in Israel

Corneal and conjunctival injury seen in urgent care centres in Israel

Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability

Point‐of‐Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta‐Analysis

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