Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9501 Euclid Ave, Cleveland, OH 44106, USA.
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9501 Euclid Ave, Cleveland, OH 44106, USA.
Am J Emerg Med. 2022 Apr;54:279-286. doi: 10.1016/j.ajem.2022.02.024. Epub 2022 Feb 22.
BACKGROUND: Both traumatic and nontraumatic ocular issues often present to the emergency department. Understanding the epidemiology of ocular presentations to the emergency department not only informs current resource allocation, but also provides opportunities to evaluate the efficacy of prior healthcare access interventions. PURPOSE: To characterize emergency department utilization in the United States for ophthalmic encounters between 2010 and 2018. METHODS: Cross-sectional analysis of the National Hospital Ambulatory Medical Care Survey database, a nationally representative sample of United States emergency department visits. 4284 deidentified emergency department patient encounters with an ICD-10 ophthalmic diagnosis from 2010 to 2018 were analyzed. The main outcome measures were the composition and characteristics of ophthalmic emergency department encounters over time. MAIN FINDINGS: 4284 ophthalmic visits were identified which represented an estimated 23.1 million visits (95% CI, 20.8 million-25.5 million). 31.6% (95% CI, 29.6-33.8) of ophthalmic visits were traumatic. Conjunctivitis was the most common non-traumatic diagnosis (32.8%, 95% CI, 30.7-35.0), while superficial injury of the cornea was the most common traumatic diagnosis (13.9%, 95% CI, 12.5-15.3). A greater proportion of emergency department visits involving the sclera and cornea were made by men (58.7%, 95% CI, 53.7%-63.6%; P = 0.02), whereas more women visited for visual disturbances (57.8%, 95% CI, 51.3%-64.4%; P = 0.01). Longitudinal trends of ophthalmic visits revealed an increase in public insurance payers in 2014, which corresponds to Medicaid expansion and implementation of mandated coverage for pediatric vision care. After stratification, this increase continued to be present in nontraumatic visits, but not traumatic ones. CONCLUSIONS: Ophthalmic emergency department visits in the United States between 2010 and 2018 were typically for non-traumatic eye issues. Diagnoses varied greatly by patient demographics, such as age and gender. Understanding these variations is valuable for preparing emergency departments for ocular presentations and providing guidance for future practice.
背景：创伤性和非创伤性眼部问题经常到急诊就诊。了解急诊眼部就诊的流行病学情况不仅可以为当前的资源分配提供信息，还可以为评估先前获得医疗保健机会的干预措施的效果提供机会。
目的：描述 2010 年至 2018 年美国眼科急诊就诊情况。
方法：对全国医院门诊医疗调查数据库进行横断面分析，该数据库是美国急诊就诊的全国代表性样本。分析了 2010 年至 2018 年期间，4284 例经 ICD-10 眼科诊断的、无身份识别的急诊患者就诊情况。主要观察指标为随时间推移的眼科急诊就诊构成和特征。
主要发现：共确定了 4284 例眼科就诊，估计有 2310 万次就诊（95%CI，2080 万-2550 万次）。31.6%（95%CI，29.6-33.8）的眼科就诊是创伤性的。结膜炎是最常见的非创伤性诊断（32.8%，95%CI，30.7-35.0%），而角膜浅层损伤是最常见的创伤性诊断（13.9%，95%CI，12.5-15.3%）。涉及巩膜和角膜的急诊就诊中，男性比例更高（58.7%，95%CI，53.7%-63.6%；P=0.02），而女性则更多地因视觉障碍就诊（57.8%，95%CI，51.3%-64.4%；P=0.01）。眼科就诊的纵向趋势显示，2014 年公共保险支付人增加，这与医疗补助扩大和强制性儿童视力保健覆盖范围的实施相对应。分层后，这种增加在非创伤性就诊中仍然存在，但在创伤性就诊中则不然。
结论：2010 年至 2018 年期间，美国的眼科急诊就诊通常是针对非创伤性眼部问题。诊断因患者年龄和性别等人口统计学特征而异。了解这些差异对于为眼部就诊做好急诊准备和为未来的实践提供指导具有重要意义。
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