University of Michigan Medical School, Ann Arbor, Michigan.
Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.
Ophthalmol Retina. 2021 Apr;5(4):330-336. doi: 10.1016/j.oret.2020.07.030. Epub 2020 Aug 11.
To determine whether an on-call system serviced by junior residents can safely triage patients with symptoms concerning for posterior vitreous detachment, retinal tear, and retinal detachment.
Quality improvement study structured as a prospective cohort study.
All symptomatic patients seen in 2017 by an on-call junior resident were followed up (257 patients). Those with follow-up within 6 months of initial presentation (228 patients, 246 unique encounters) were included.
We prospectively tracked all symptomatic patients seen on-call by a junior resident in 2017 at a major academic medical center.
Incidence and predictors of true retinal tears or detachments, false-positive tears or detachments, false-negative tears or detachments, and resource use.
Of 246 symptomatic encounters, 83 (33.7%) had a perceived retinal tear or detachment. Residents used B-scan ultrasonography in a high number of encounters (41.0%). Ten (4.1%) false-positive tears or detachments were identified, with the presence of intraretinal hemmorhage predicting a false-positive examination (adjusted odds ratio, 3.86; 95% confidence interval, 1.1-13.5). Thirteen (5.3%) false-negative tears and no false-negative detachments were identified. Eleven (84.6%) false-negative tears underwent follow-up within days based on high-risk characteristics, and no false-negative tears progressed to detachment at follow-up. Measures of resource use included an in-person confirmation of examination findings by the senior resident or fellow in 59 encounters (24.0%) and shorter follow-up times to a retina rather than a nonretina clinic for 52 of 151 patients who showed no pathologic features on initial examination.
Junior residents can safely provide on-call triage of patients with symptoms concerning for a posterior vitreous detachment, retinal tear, or retinal detachment. The system requires moderate resource use, including occasional confirmatory examinations by a second physician and shorter follow-up times to retina clinic for high-risk patients.
确定由初级住院医师提供的随叫随到系统是否能够安全地对有后玻璃体脱离、视网膜裂孔和视网膜脱离症状的患者进行分诊。
质量改进研究，采用前瞻性队列研究。
对 2017 年由随叫随到的初级住院医师接诊的所有有症状的患者进行随访（257 例患者）。对初始就诊后 6 个月内有随访记录的患者（228 例患者，246 个单独就诊）进行纳入分析。
我们前瞻性地跟踪了 2017 年在一家主要学术医疗中心由初级住院医师随叫随到的所有有症状的患者。
真性视网膜裂孔或脱离、假阳性裂孔或脱离、假阴性裂孔或脱离的发生率和预测因素，以及资源使用情况。
在 246 个有症状的就诊中，有 83 例（33.7%）被认为有视网膜裂孔或脱离。住院医师在大量就诊中使用了 B 型超声检查（41.0%）。发现了 10 例（4.1%）假阳性裂孔或脱离，视网膜内出血的存在可预测检查结果为假阳性（调整后的优势比，3.86；95%置信区间，1.1-13.5）。发现 13 例（5.3%）假阴性裂孔，没有假阴性脱离。根据高危特征，11 例（84.6%）假阴性裂孔在数天内进行了随访，且在随访中没有假阴性裂孔进展为脱离。资源使用的衡量标准包括在 59 次就诊中由高级住院医师或研究员进行了对检查结果的亲自确认（24.0%），以及对 151 例初始检查无病理性特征的患者中有 52 例转到视网膜科而非非视网膜科进行较短的随访时间。
初级住院医师可以安全地对有后玻璃体脱离、视网膜裂孔或视网膜脱离症状的患者进行随叫随到分诊。该系统需要适度的资源使用，包括偶尔由第二位医生进行确认检查，以及对高危患者进行较短的视网膜科随访。
