Characterization of ophthalmic presentations to emergency departments in the United States: 2010–2018

Abstract

BackgroundBoth traumatic and nontraumatic ocular issues often present to the emergency department. Understanding the epidemiology of ocular presentations to the emergency department not only informs current resource allocation, but also provides opportunities to evaluate the efficacy of prior healthcare access interventions. PurposeTo characterize emergency department utilization in the United States for ophthalmic encounters between 2010 and 2018. MethodsCross-sectional analysis of the National Hospital Ambulatory Medical Care Survey database, a nationally representative sample of United States emergency department visits. 4284 deidentified emergency department patient encounters with an ICD-10 ophthalmic diagnosis from 2010 to 2018 were analyzed. The main outcome measures were the composition and characteristics of ophthalmic emergency department encounters over time. Main findings4284 ophthalmic visits were identified which represented an estimated 23.1 million visits (95% CI, 20.8 million—25.5 million). 31.6% (95% CI, 29.6—33.8) of ophthalmic visits were traumatic. Conjunctivitis was the most common non-traumatic diagnosis (32.8%, 95% CI, 30.7—35.0), while superficial injury of the cornea was the most common traumatic diagnosis (13.9%, 95% CI, 12.5—15.3). A greater proportion of emergency department visits involving the sclera and cornea were made by men (58.7%, 95% CI, 53.7%–63.6%; P = 0.02), whereas more women visited for visual disturbances (57.8%, 95% CI, 51.3%–64.4%; P = 0.01). Longitudinal trends of ophthalmic visits revealed an increase in public insurance payers in 2014, which corresponds to Medicaid expansion and implementation of mandated coverage for pediatric vision care. After stratification, this increase continued to be present in nontraumatic visits, but not traumatic ones. ConclusionsOphthalmic emergency department visits in the United States between 2010 and 2018 were typically for non-traumatic eye issues. Diagnoses varied greatly by patient demographics, such as age and gender. Understanding these variations is valuable for preparing emergency departments for ocular presentations and providing guidance for future practice.