Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Kensington Vision and Research Centre, Toronto, Ont.; St. Michael's Hospital, Toronto, Ont.; Mount Sinai Hospital, Toronto, Ont.
Can J Ophthalmol. 2018 Dec;53(6):639-645. doi: 10.1016/j.jcjo.2018.03.006. Epub 2018 May 28.
To assess the characteristics of referrals to academic uveitis tertiary care centres in Toronto and identify determinants of wait time for consultation.
Retrospective case series.
Consecutive new uveitis referrals received at 5 University of Toronto-affiliated uveitis tertiary care centres, between February 2016 and November 2016, were included.
A total of 159 new uveitis referrals were received from academic (69%) and community (31%) providers. A large proportion of referrals were sent by comprehensive ophthalmologists (33%) and retina specialists (38%). Disease was bilateral in 46% of cases, had an acute onset in 43% of cases, and was classified as posterior uveitis in 38% of cases. Disease etiology at the time of referral was unknown in 55% of cases. Only 43% of all referrals included a basic uveitis workup, and patients who had undergone diagnostic testing had a shorter wait time for consultation (41 ± 43 vs. 59 ± 54 days, p = 0.033). Acute uveitis had a shorter wait time compared with recurrent and chronic uveitis (33 ± 42 vs. 66 ± 44 and 59 ± 58 days, p < 0.001). Referrals triaged as urgent had significantly shorter wait times compared with referrals triaged as semiurgent or elective (7 ± 10 vs. 54 ± 43 and 88 ± 59, p < 0.001).
Referrals to academic uveitis tertiary care centres in Toronto are often acute, bilateral cases affecting the posterior segment without a known etiology. Approximately half of referrals include no diagnostic workup, which may delay diagnosis for patients and lengthen wait times for consultation. We provide a set of recommendations for investigations that should be included in uveitis referrals.
评估多伦多大学附属眼科学系葡萄膜炎三级诊疗中心的转诊特点，并确定其就诊等候时间的决定因素。
回顾性病例系列研究。
纳入 2016 年 2 月至 2016 年 11 月期间，在多伦多的 5 所大学附属葡萄膜炎三级诊疗中心接收的连续新葡萄膜炎转诊患者。
共接收 159 例新葡萄膜炎转诊患者，分别来自学术（69%）和社区（31%）医疗机构。很大比例的转诊来自综合眼科医生（33%）和视网膜专家（38%）。46%的病例为双眼疾病，43%的病例为急性发作，38%的病例为后葡萄膜炎。55%的病例在转诊时病因不明。所有转诊中只有 43%包括基本的葡萄膜炎检查，接受过诊断性检查的患者其就诊等候时间更短（41±43 天 vs. 59±54 天，p=0.033）。与复发性和慢性葡萄膜炎相比，急性葡萄膜炎的就诊等候时间更短（33±42 天 vs. 66±44 天和 59±58 天，p<0.001）。被分诊为紧急的转诊比被分诊为半紧急或择期的转诊等候时间明显更短（7±10 天 vs. 54±43 天和 88±59 天，p<0.001）。
多伦多大学葡萄膜炎三级诊疗中心的转诊通常为急性、双侧、累及后节且病因不明的病例。大约一半的转诊未进行任何诊断性检查，这可能会延迟患者的诊断，并延长就诊等候时间。我们提出了一套葡萄膜炎转诊中应包括的检查建议。
