Brooke Army Medical Center, 3551 Roger Brooke Dr., Fort Sam Houston, TX 78234, USA; University of Cincinnati College of Medicine, 3230 Eden Ave., Cincinnati, OH 45267, USA.
Brooke Army Medical Center, 3551 Roger Brooke Dr., Fort Sam Houston, TX 78234, USA.
Am J Emerg Med. 2022 Jul;57:42-46. doi: 10.1016/j.ajem.2022.04.025. Epub 2022 Apr 27.
Facial trauma and orbital fractures are common reasons for ophthalmology consultation in the emergency department (ED). The purpose of this study is to assess intervention rates and evaluate the acuity of ophthalmology consultation for orbital fractures in the ED.
A retrospective chart review of orbital fractures was conducted over a 23-month period. 379 cases of orbital fractures were identified in a single-center study. All patients that received an ophthalmology consultation in the ED were included. Demographics, mechanism and location of orbital fracture, ophthalmic complications, and surgical and non-surgical ophthalmic interventions were recorded. The primary study outcome was the rate of ophthalmic consultation and intervention with and without retrospective application of our proposed South Texas Orbital Fracture Protocol (STOP).
Immediate ophthalmic intervention was performed in 18.7% of patients. Statistically significant subjective, radiographic, and physical exam features correlating with ophthalmic intervention were identified and included globe rupture, concern for entrapment, orbital roof fractures, and retrobulbar hematoma. Retrospective application of our proposed South Texas Orbital Fracture Protocol (STOP) would have resulted in 186 of 379 patients requiring ophthalmology consultation, thus reducing consultation rate by 51% with an improved rate of intervention from 18.7% to 37.6%.
Orbital fractures can be associated with severe ocular complications. Most cases, however, do not require emergent evaluation by an ophthalmologist. We propose the South Texas Orbital Fracture Protocol (STOP) for proper assessment and triaging of orbital fractures in the ED. While this clinical decision-making tool requires validation, it may offer improved healthcare efficiency, reduced costs, fewer unnecessary inter-facility transfers, and less burnout for ophthalmology residents.
面部创伤和眼眶骨折是急诊科眼科会诊的常见原因。本研究旨在评估干预率，并评估急诊科眼眶骨折眼科会诊的紧迫性。
对眼眶骨折进行了为期 23 个月的回顾性图表审查。在一项单中心研究中，确定了 379 例眼眶骨折。所有在急诊科接受眼科会诊的患者均包括在内。记录了患者的人口统计学资料、眼眶骨折的机制和部位、眼部并发症以及手术和非手术眼科干预措施。主要研究结果是眼科会诊和干预的比率，包括有无回顾性应用我们提出的南德克萨斯眼眶骨折方案（STOP）。
18.7%的患者立即进行了眼科干预。确定了与眼科干预相关的具有统计学意义的主观、放射学和体格检查特征，包括眼球破裂、眶隔嵌顿、眶顶骨折和眶内血肿。回顾性应用我们提出的南德克萨斯眼眶骨折方案（STOP）将导致 379 例患者中有 186 例需要眼科会诊，从而使会诊率降低 51%，干预率从 18.7%提高到 37.6%。
眼眶骨折可伴有严重的眼部并发症。然而，大多数病例并不需要眼科医生紧急评估。我们提出南德克萨斯眼眶骨折方案（STOP）用于正确评估和分诊急诊科眼眶骨折。虽然这种临床决策工具需要验证，但它可能提供改善的医疗效率、降低成本、减少不必要的机构间转移以及减轻眼科住院医师的倦怠。
