University of British Columbia Southern Medical Program, Kelowna, B.C.
University of British Columbia Department of Ophthalmology and Visual Sciences, Vancouver, B.C.
Can J Ophthalmol. 2019 Aug;54(4):484-488. doi: 10.1016/j.jcjo.2018.08.010. Epub 2018 Oct 19.
This study was conducted to analyse data from emergency ophthalmology referrals after-hours from different hospitals to identify the most common pathologies and compare accuracy of diagnoses. The primary objective was to identify common presenting entities and common causes of misdiagnosis in the emergency department to help guide education initiatives.
This was a retrospective chart review that looked at consults occurring between September 1, 2015, and October 21, 2016.
Emergency ophthalmology consults were reviewed and the date, time, age, sex, and provisional diagnosis were recorded. Ophthalmic diagnosis was compared with provisional diagnosis to compare agreement rate. Diagnoses were categorized to determine most frequent etiologies presenting on an emergent basis.
A total of 697 consults were reviewed. The most common consults by diagnostic category were anterior segment (36.4%) and posterior segment (27.4%) pathologies. Together, these categories accounted for over 60% of all consults. Agreement between provisional diagnosis and final ophthalmology diagnosis was 65.8%.
There was a reasonable agreement rate between referring services diagnosis and ophthalmology diagnosis. The retrospective nature of this study and use of categories to determine agreement are potential biases and the agreement rate may not reflect clinical practice. Most common diagnoses were similar to previous studies. The authors noted several diagnostic categories that could be targeted as areas for medical education to help increase recognition in the primary care setting and facilitate appropriate ophthalmic referral.
本研究旨在分析来自不同医院下班后急诊眼科转诊的数据，以确定最常见的疾病，并比较诊断的准确性。主要目的是确定急诊科常见的表现实体和常见的误诊原因，以帮助指导教育计划。
这是一项回顾性图表审查，研究对象为 2015 年 9 月 1 日至 2016 年 10 月 21 日期间的咨询。
对急诊眼科咨询进行了审查，并记录了日期、时间、年龄、性别和临时诊断。将眼科诊断与临时诊断进行比较，以比较一致性率。对诊断进行分类，以确定最常见的紧急发病病因。
共审查了 697 次咨询。按诊断类别分类，最常见的咨询是前节（36.4%）和后节（27.4%）疾病。这两个类别加起来占所有咨询的 60%以上。临时诊断和最终眼科诊断之间的一致性为 65.8%。
转诊服务诊断和眼科诊断之间存在合理的一致性。本研究的回顾性性质和使用类别来确定一致性是潜在的偏差，一致性率可能无法反映临床实践。最常见的诊断与之前的研究相似。作者指出了几个可以作为医学教育目标的诊断类别，以帮助提高初级保健环境中的识别能力，并促进适当的眼科转诊。
