Abstract
To investigate the epidemiology of eye-related emergency department (ED) visits and to determine if visual acuity (VA) could be an indicator for determining the timing for managing ocular emergencies, we have conducted the retrospective study which included patients visited the ED for eye-related reasons and had received ophthalmology consultations at a referral center in Taiwan in 2015. Among 46,514 consultations, 5,493 were ophthalmology consultations (11.8%). After exclusion, 5,422 were eligible for analysis. Among them, 1,165 (21.5%) had not likely emergent diagnoses, 4,048 (74.7%) had likely emergent diagnoses, and 209 patients (3.9%) could not be determined. The logMAR VA was 0.31 ± 0.48, 0.66 ± 0.78, and 1.00 ± 0.94 in groups with not likely emergent, likely emergent, and undetermined diagnoses, respectively. Among all eye-related ED visits, 10.3% of patients received ophthalmologic intervention or were admitted to the ophthalmology ward. A LogMAR VA score of 0.45 (decimal equivalent of 0.4) had the highest discrimination power for identifying whether a patient needed ophthalmology intervention or admission to ophthalmology ward (area under the curve: 0.802, sensitivity: 0.800, specificity: 0.672). In our study, we found VA could be an indicator for determining the priority and time of ocular emergencies requiring ophthalmic intervention in patients visiting the ED for eye-related reasons.
Highlights
The cost of emergency department (ED) visits in Taiwan is covered by Taiwan’s National Health Insurance, making Taiwan health care renowned for its low cost and overloaded services[5]
We used visual acuity (VA) as an indicator for identifying real ophthalmic emergency, and our result suggested that VA had a good predicting power for eye-related ED visits requiring ophthalmologic intervention or admission to the ophthalmology ward (AUC = 0.801)
Compared with a French study that reported a total 781 eye-related ED visits at three medical centers requesting ophthalmology consultations during 3 months[22], the number of eye-related ED visits with ophthalmology consultations in our study at a single medical center was relatively sufficient. This is the first study to analyze the epidemiology of eye-related ED visits with ophthalmology consultation in Taiwan
Summary
The cost of ED visits in Taiwan is covered by Taiwan’s National Health Insurance, making Taiwan health care renowned for its low cost and overloaded services[5]. Regarding to the United States, where overall, eye-related ED visits cost approximately US$2 billion annually, the mean charges of an emergent and a nonemergent eye-related ED visit are US$1,266 and US$613, respectively[3]. This considerable difference in medical fees makes visiting the ED relatively common in Taiwan. We conducted this study to understand the epidemiology of all-cause eye-related ED visits with ophthalmology consultation in Taiwan and to investigate visual acuity (VA) as an indicator for determining the timing for managing ocular emergencies
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