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Epidemiological and clinical features of eye-related emergency department visits involving an ophthalmology consultation in geriatrics

Year 2022, Volume: 8 Issue: 2, 158 - 165, 01.05.2022
https://doi.org/10.53394/akd.1057689

Abstract

ABSTRACT
Objective: This study aimed to examine the epidemiological and clinical characteristics of geriatric patients who presented to the emergency department (ED) with ocular complaints and were referred for an ophthalmology consultation and to evaluate the efficacy of visual acuity (VA) as an indicator of urgency of care.
Material and Methods: The data of 730 patients were retrospectively analyzed. Age, gender, presentation complaints, presentation time, pre-diagnoses made by the ED physician, definitive diagnosis, VA (logMAR) measurements and urgency of care were recorded.
Results: The mean age of the patients was 72.7 ± 7.1 years. The percentage of patients presenting to ED during evening shift hours was 60.3%, and the rate of presentation on weekdays was 75.8% (p<0.05). The agreement rate between the pre-diagnosis of the ED physicians and the final diagnosis of the ophthalmologists was 65.2%. The most common reasons for presenting to ED were infection (21%) and trauma (19.9%). No pathological finding was present in 10.1%. According to the classification of urgency of care, 52.6% of the cases were evaluated as urgent, 24.3% as semi-urgent, and 23.1% as non-urgent. VA was the lowest (1.49 ± 1.06 logMAR) in the urgent group (p<0.01).
Conclusion: We consider that low VA can be of great help in evaluating the urgency of geriatric patients presenting to ED. In addition, rather than ED, geriatric patients applying to health institutions where they can receive outpatient clinic service for non-emergency ocular diseases may allow ED to provide better service to other patients with more serious problems.
Key Words: Geriatrics, Emergency department, Eye-related emergency, Ocular emergency

References

  • 1. T.R. Prime Minister of Turkey, Turkish Statistical Institute’s data 2020, (TurkStat, Population Censuses, 1935 - 2000; TurkStat, Address Based Population Registrarion System, 2008 - 2019; TurkStat, Population Projections, 2023 - 2080) https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Yaslilar-2019-33712.
  • 2. Arai H, Ouchi Y, Yokode M, Ito H, Uematsu H, Eto F, Oshima S, Ota K, Saito Y, Sasaki H, Tsubota K, Fukuyama H, Honda Y, Iguchi A, Toba K, Hosoi T, Kita T; Members of Subcommittee for Aging. Toward the realization of a better aged society: messages from gerontology and geriatrics. Geriatr Gerontol Int. 2012;12(1):16-22.
  • 3. Shankar KN, Bhatia BK, Schuur JD. Toward patient-centered care: a systematic review of older adults' views of quality emergency care. Ann Emerg Med. 2014;63(5):529-550.e1.
  • 4. Unsal A, Ayranci U, Alper Cevik A, Metintas S, Arslantas D, Unluoglu I. Use of emergency departments by elderly patients in a city of Western Turkey. Eur J Emerg Med. 2007;14(3):125-9.
  • 5. Unsal A, Cevik AA, Metintas S, Arslantas D, Inan OÇ. Yaşli hastalarin acil servis başvuruları. Turkish Journal of Geriatrics 2003;6(3):83-8.
  • 6. Kahn JH, Magauran BG Jr, Olshaker JS, Shankar KN. Current Trends in Geriatric Emergency Medicine. Emerg Med Clin North Am. 2016;34(3):435-52.
  • 7. Laforge RG, Spector WD, Sternberg J. The relationship of vision and hearing impairment to one-year mortality and functional decline. J Aging Health. 1992;4:126-48.
  • 8. Vaziri K, Schwartz SG, Flynn HW Jr, Kishor KS, Moshfeghi AA. Eye-related Emergency Department Visits in the United States, 2010. Ophthalmology. 2016;123(4):917-9.
  • 9. Gordon KD. The incidence of eye injuries in Canada. Can J Ophthalmol. 2012;47(4):351-3.
  • 10. Stagg BC, Shah MM, Talwar N, Padovani-Claudio DA, Woodward MA, Stein JD. Factors Affecting Visits to the Emergency Department for Urgent and Nonurgent Ocular Conditions. Ophthalmology. 2017;124(5):720-729.
  • 11. Channa R, Zafar SN, Canner JK, Haring RS, Schneider EB, Friedman DS. Epidemiology of Eye-Related Emergency Department Visits. JAMA Ophthalmol. 2016;134(3):312-9.
  • 12. Bernstein SL, Aronsky D, Duseja R, Epstein S, Handel D, Hwang U, McCarthy M, John McConnell K, Pines JM, Rathlev N, Schafermeyer R, Zwemer F, Schull M, Asplin BR; Society for Academic Emergency Medicine, Emergency Department Crowding Task Force. The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med. 2009;16(1):1-10.
  • 13. Docherty G, Hwang J, Yang M, Eadie B, Clapson K, Siever J, Warner SJ. Prospective analysis of emergency ophthalmic referrals in a Canadian tertiary teaching hospital. Can J Ophthalmol. 2018;53(5):497-502.
  • 14. Yüksel H, Türkcü FM, Çınar Y, Cingü AK, Sahin A, Sahin M, Özkurt Z, Murat M, Çaça I. Etiology and prognosis of penetrating eye injuries in geriatric patients in the Southeastern region of Anatolia Turkey. Ulus Travma Acil Cerrahi Derg. 2014;20(4):253-7.
  • 15. Andreoli MT, Andreoli CM. Geriatric traumatic open globe injuries. Ophthalmology. 2011;118(1):156-9.
  • 16. Kang EY, Tai WC, Lin JY, Huang CJ, Yeh PH, Wu WC, Wang FL, Liu L, Lai CC, Chen KJ. Eye-related Emergency Department Visits with Ophthalmology Consultation in Taiwan: Visual Acuity as an Indicator of Ocular Emergency. Sci Rep. 2020;10(1):982.
  • 17. Olthoff CM, Schouten JS, van de Borne BW, Webers CA. Noncompliance with ocular hypotensive treatment in patients with glaucoma or ocular hypertension an evidence-based review. Ophthalmology. 2005;112(6):953-61.
  • 18. Schwartz GF, Quigley HA. Adherence and persistence with glaucoma therapy. Surv Ophthalmol. 2008;53 Suppl1:S57-68.
  • 19. Stewart WC, Chorak RP, Hunt HH, Sethuraman G. Factors associated with visual loss in patients with advanced glaucomatous changes in the optic nerve head. Am J Ophthalmol. 1993;116(2):176-81.
  • 20. Rossi GC, Pasinetti GM, Scudeller L, Radaelli R, Bianchi PE. Do adherence rates and glaucomatous visual field progression correlate? Eur J Ophthalmol. 2011;21(4):410-4.
  • 21. Sleath B, Blalock S, Covert D, Stone JL, Skinner AC, Muir K, Robin AL. The relationship between glaucoma medication adherence, eye drop technique, and visual field defect severity. Ophthalmology. 2011;118(12):2398-402.
  • 22. Paula JS, Furtado JM, Santos AS, Coelho Rde M, Rocha EM, Rodrigues Mde L. Risk factors for blindness in patients with open-angle glaucoma followed-up for at least 15 years. Arq Bras Oftalmol. 2012;75(4):243-6.
  • 23. Rossi T, Boccassini B, Cedrone C, Iossa M, Mutolo MG, Lesnoni G, Mutolo PA. Testing the reliability of an eye-dedicated triaging system: the RESCUE. Eur J Ophthalmol. 2008;18(3):445-9.
  • 24. Chang CH, Chen CL, Ho CK, Lai YH, Hu RC, Yen YL. Hospitalized eye injury in a large industrial city of South-Eastern Asia. Graefes Arch Clin Exp Ophthalmol. 2008;246(2):223-8.
  • 25. Godbole NJ, Seefeldt ES, Raymond WR, Karesh JW, Morgenstern A, Egan JA, Colyer MH, Mazzoli RA. Simplified Method for Rapid Field Assessment of Visual Acuity by First Responders After Ocular Injury. Mil Med. 2018;183(suppl_1):219-223.

Acil servise başvuran ve oftalmoloji konsültasyonu istenen geriatrik hastaların epidemiyolojik ve klinik özelliklerinin belirlenmesi

Year 2022, Volume: 8 Issue: 2, 158 - 165, 01.05.2022
https://doi.org/10.53394/akd.1057689

Abstract

ÖZ
Giriş: Oküler şikayetle acil servise (AS) başvuran ve oftalmoloji konsültasyonu istenen geriatrik hastaların epidemiyolojik ve klinik özelliklerinin incelenmesi; görme keskinliğinin aciliyet göstergesi olarak etkinliğinin değerlendirilmesi.
Gereç ve Yöntemler: Yedi yüz otuz hastanın verileri retrospektif olarak incelendi. Yaş, cinsiyet, başvuru şikayetleri, başvuru zamanı, AS hekimi tarafından konulan ön tanıları, kesin tanıları, görme keskinlikleri (logMAR), aciliyet durumları kaydedildi.
Bulgular: Hastaların yaş ortalaması 72,7 ± 7,1 idi. Saat olarak akşam vardiyasında AS başvuru oranı %60,3; gün dağılımda da hafta içi başvuru oranları da %75,8 idi (p<0.05). Acil hekimlerin ön tanısı ile oftalmologların kesin tanı uyum oranı %65,2 idi. Hastaların en sık başvuru nedeninin enfeksiyon (%21) ve travma (%19,9) olduğu görüldü. Hastaların %10,1’inde patolojik bulgu izlenmedi. Aciliyet sınıflamasına baktığımız zaman ise %52,6 hasta acil, %24,3 hasta yarıacil ve %23,1 hasta acil olmayan olarak değerlendirildi. Görme keskinliğinin acil grupta en düşük (1,49±1,06 logMAR), acil olmayan grupta (72,82±7,3 logMAR) en yüksekti (p<0.01).
Sonuç: Özellikle AS başvuran geriatrik hastaların aciliyet durumlarının değerlendirilmesinde düşük görme keskinliğinin bize oldukça yardımcı olabileceğini düşünmekteyiz. Ayrıca hastaları acil olmayan oküler hastalıklar için AS başvurmak yerine, poliklinik hizmeti alabilecekleri sağlık kuruluşlarına başvurmaları AS daha ciddi sorunları olan hastalara daha iyi hizmet vermesine olanak sağlayabileceğini düşünmekteyiz.
Anahtar Sözcükler: Geriatrik, Acil servis, Gözle ilişkili aciller, Oküler aciller

References

  • 1. T.R. Prime Minister of Turkey, Turkish Statistical Institute’s data 2020, (TurkStat, Population Censuses, 1935 - 2000; TurkStat, Address Based Population Registrarion System, 2008 - 2019; TurkStat, Population Projections, 2023 - 2080) https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Yaslilar-2019-33712.
  • 2. Arai H, Ouchi Y, Yokode M, Ito H, Uematsu H, Eto F, Oshima S, Ota K, Saito Y, Sasaki H, Tsubota K, Fukuyama H, Honda Y, Iguchi A, Toba K, Hosoi T, Kita T; Members of Subcommittee for Aging. Toward the realization of a better aged society: messages from gerontology and geriatrics. Geriatr Gerontol Int. 2012;12(1):16-22.
  • 3. Shankar KN, Bhatia BK, Schuur JD. Toward patient-centered care: a systematic review of older adults' views of quality emergency care. Ann Emerg Med. 2014;63(5):529-550.e1.
  • 4. Unsal A, Ayranci U, Alper Cevik A, Metintas S, Arslantas D, Unluoglu I. Use of emergency departments by elderly patients in a city of Western Turkey. Eur J Emerg Med. 2007;14(3):125-9.
  • 5. Unsal A, Cevik AA, Metintas S, Arslantas D, Inan OÇ. Yaşli hastalarin acil servis başvuruları. Turkish Journal of Geriatrics 2003;6(3):83-8.
  • 6. Kahn JH, Magauran BG Jr, Olshaker JS, Shankar KN. Current Trends in Geriatric Emergency Medicine. Emerg Med Clin North Am. 2016;34(3):435-52.
  • 7. Laforge RG, Spector WD, Sternberg J. The relationship of vision and hearing impairment to one-year mortality and functional decline. J Aging Health. 1992;4:126-48.
  • 8. Vaziri K, Schwartz SG, Flynn HW Jr, Kishor KS, Moshfeghi AA. Eye-related Emergency Department Visits in the United States, 2010. Ophthalmology. 2016;123(4):917-9.
  • 9. Gordon KD. The incidence of eye injuries in Canada. Can J Ophthalmol. 2012;47(4):351-3.
  • 10. Stagg BC, Shah MM, Talwar N, Padovani-Claudio DA, Woodward MA, Stein JD. Factors Affecting Visits to the Emergency Department for Urgent and Nonurgent Ocular Conditions. Ophthalmology. 2017;124(5):720-729.
  • 11. Channa R, Zafar SN, Canner JK, Haring RS, Schneider EB, Friedman DS. Epidemiology of Eye-Related Emergency Department Visits. JAMA Ophthalmol. 2016;134(3):312-9.
  • 12. Bernstein SL, Aronsky D, Duseja R, Epstein S, Handel D, Hwang U, McCarthy M, John McConnell K, Pines JM, Rathlev N, Schafermeyer R, Zwemer F, Schull M, Asplin BR; Society for Academic Emergency Medicine, Emergency Department Crowding Task Force. The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med. 2009;16(1):1-10.
  • 13. Docherty G, Hwang J, Yang M, Eadie B, Clapson K, Siever J, Warner SJ. Prospective analysis of emergency ophthalmic referrals in a Canadian tertiary teaching hospital. Can J Ophthalmol. 2018;53(5):497-502.
  • 14. Yüksel H, Türkcü FM, Çınar Y, Cingü AK, Sahin A, Sahin M, Özkurt Z, Murat M, Çaça I. Etiology and prognosis of penetrating eye injuries in geriatric patients in the Southeastern region of Anatolia Turkey. Ulus Travma Acil Cerrahi Derg. 2014;20(4):253-7.
  • 15. Andreoli MT, Andreoli CM. Geriatric traumatic open globe injuries. Ophthalmology. 2011;118(1):156-9.
  • 16. Kang EY, Tai WC, Lin JY, Huang CJ, Yeh PH, Wu WC, Wang FL, Liu L, Lai CC, Chen KJ. Eye-related Emergency Department Visits with Ophthalmology Consultation in Taiwan: Visual Acuity as an Indicator of Ocular Emergency. Sci Rep. 2020;10(1):982.
  • 17. Olthoff CM, Schouten JS, van de Borne BW, Webers CA. Noncompliance with ocular hypotensive treatment in patients with glaucoma or ocular hypertension an evidence-based review. Ophthalmology. 2005;112(6):953-61.
  • 18. Schwartz GF, Quigley HA. Adherence and persistence with glaucoma therapy. Surv Ophthalmol. 2008;53 Suppl1:S57-68.
  • 19. Stewart WC, Chorak RP, Hunt HH, Sethuraman G. Factors associated with visual loss in patients with advanced glaucomatous changes in the optic nerve head. Am J Ophthalmol. 1993;116(2):176-81.
  • 20. Rossi GC, Pasinetti GM, Scudeller L, Radaelli R, Bianchi PE. Do adherence rates and glaucomatous visual field progression correlate? Eur J Ophthalmol. 2011;21(4):410-4.
  • 21. Sleath B, Blalock S, Covert D, Stone JL, Skinner AC, Muir K, Robin AL. The relationship between glaucoma medication adherence, eye drop technique, and visual field defect severity. Ophthalmology. 2011;118(12):2398-402.
  • 22. Paula JS, Furtado JM, Santos AS, Coelho Rde M, Rocha EM, Rodrigues Mde L. Risk factors for blindness in patients with open-angle glaucoma followed-up for at least 15 years. Arq Bras Oftalmol. 2012;75(4):243-6.
  • 23. Rossi T, Boccassini B, Cedrone C, Iossa M, Mutolo MG, Lesnoni G, Mutolo PA. Testing the reliability of an eye-dedicated triaging system: the RESCUE. Eur J Ophthalmol. 2008;18(3):445-9.
  • 24. Chang CH, Chen CL, Ho CK, Lai YH, Hu RC, Yen YL. Hospitalized eye injury in a large industrial city of South-Eastern Asia. Graefes Arch Clin Exp Ophthalmol. 2008;246(2):223-8.
  • 25. Godbole NJ, Seefeldt ES, Raymond WR, Karesh JW, Morgenstern A, Egan JA, Colyer MH, Mazzoli RA. Simplified Method for Rapid Field Assessment of Visual Acuity by First Responders After Ocular Injury. Mil Med. 2018;183(suppl_1):219-223.
There are 25 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Article
Authors

Aslı Çetinkaya Yaprak This is me 0000-0002-4285-419X

Hatice Deniz İlhan This is me 0000-0002-5085-4763

Early Pub Date April 24, 2022
Publication Date May 1, 2022
Submission Date May 26, 2021
Published in Issue Year 2022 Volume: 8 Issue: 2

Cite

Vancouver Çetinkaya Yaprak A, İlhan HD. Epidemiological and clinical features of eye-related emergency department visits involving an ophthalmology consultation in geriatrics. Akd Med J. 2022;8(2):158-65.