Parvataneni Mrunalini, Christiansen Stephen P, Jensen Allison A, Summers C Gail
Department of Ophthalmology,University of Minnesota Medical School, Minneapolis, Minnesota, USA.
J AAPOS. 2005 Feb;9(1):22-5. doi: 10.1016/j.jaapos.2004.09.007.
The early detection and management of common pediatric ophthalmic problems is crucial to assure successful visual maturation and best potential for development of binocular vision. The referring physician plays a pivotal role in this process. This study was designed to investigate the prevailing referral patterns for common amblyogenic conditions in a defined geographic region.
We sent a short questionnaire to 300 pediatricians and 1500 family practitioners (FPs) in Minnesota, asking them to use a multiple choice system to indicate how long after diagnosis they would wait before referring a child to an ophthalmologist for exotropia, esotropia, ptosis, nystagmus, and abnormal red reflex.
The response rate was 46.9% ( n = 117) for pediatricians and 17.9% ( n = 240) for FPs. Of respondents, 64.6% of pediatricians and 50.2% of FPs would refer patients with exotropia within 2 months of diagnosis ( P < 0.001). For esotropia, 58.8% of pediatricians would refer within 2 months, while 38.6% would wait up to 12 months. In comparison, 48.7% of FPs would refer sooner, while 47.9% would refer later. These differences in referral patterns for pediatricians and FPs were statistically significant ( P = 0.037). There was less variation for referral of ptosis, nystagmus, and abnormal red reflex. These referral patterns were unaffected by years in practice.
Pediatricians referred patients with strabismus significantly more promptly than FPs. The majority of primary care providers (PCPs) appropriately timed their referrals for these amblyogenic conditions. However, many children continue to be referred late, underscoring the need for continued education of PCPs.
常见儿童眼科问题的早期检测和管理对于确保视觉成熟成功以及双眼视觉发育的最佳潜力至关重要。转诊医生在这一过程中起着关键作用。本研究旨在调查特定地理区域内常见致弱视病症的普遍转诊模式。
我们向明尼苏达州的300名儿科医生和1500名家庭医生发送了一份简短问卷，要求他们使用多项选择系统表明在诊断后多久会将患有外斜视、内斜视、上睑下垂、眼球震颤和异常红反射的儿童转诊给眼科医生。
儿科医生的回复率为46.9%（n = 117），家庭医生的回复率为17.9%（n = 240）。在受访者中，64.6%的儿科医生和50.2%的家庭医生会在诊断后2个月内转诊外斜视患者（P < 0.001）。对于内斜视，58.8%的儿科医生会在2个月内转诊，而38.6%的医生会等待长达12个月。相比之下，48.7%的家庭医生会更早转诊，而47.9%的医生会更晚转诊。儿科医生和家庭医生在转诊模式上的这些差异具有统计学意义（P = 0.037）。上睑下垂、眼球震颤和异常红反射的转诊差异较小。这些转诊模式不受从业年限的影响。
儿科医生转诊斜视患者的速度明显比家庭医生快。大多数初级保健提供者（PCP）对这些致弱视病症的转诊时机把握得当。然而，许多儿童仍被转诊得较晚，这突出了对初级保健提供者持续教育的必要性。
