Fernandez Elise O, Miller Hannah M, Pham Vincent Q, Fleischman David
School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
Department of Ophthalmology, University of North Carolina, Chapel Hill, NC, USA.
Clin Ophthalmol. 2022 Aug 22;16:2733-2742. doi: 10.2147/OPTH.S378049. eCollection 2022.
It is widely accepted in the field of ophthalmology that closure of open globes within 24 hours of the injury results in the best visual outcomes. This study investigates the time-to-surgery and visual outcomes of open globe injury patients in North Carolina that were transferred to our institution before receiving surgical intervention as compared to those that were not transferred.
This is a retrospective cohort study using data from UNC Hospitals trauma registry. Demographics, time of injury, final clinical outcomes, time to surgical intervention, and transfer history were extracted and analyzed. The study population includes open globe injury patients of all ages that were seen and treated at our institution from 2005 to 2020. Patients were divided based on transfer history. The transfer group consisted of patients who were transferred from an outside hospital to our tertiary care facility for surgical treatment. The non-transfer group consisted of patients who arrived at our tertiary care facility directly after injury.
In total, 238 open globe injuries were evaluated. Of those, 197 were transferred and 41 were not transferred. Compared to non-transfer patients, transfer patients had longer delays between injury and surgery, between presentation at the initial ED and surgery, and between injury and arrival at the tertiary care center. On average, the delay between injury and surgical intervention was 3 hours and 51 minutes longer for transfer patients compared to non-transfer patients. Eight patients in the transfer group were delayed >24 hours due to inter-hospital transfer. Additionally, transfer patients on average suffered from poorer final visual acuities, with an average final visual acuity of 1.84 logMAR in the transfer group and 1.35 logMAR in the non-transfer group.
Our study found that inter-hospital transfer leads to significant delays in primary closure of open globe injuries. Injuries that were transferred to a tertiary care center before receiving surgical intervention on average resulted in worse final visual acuities.
眼科领域广泛认为，开放性眼球损伤后24小时内进行闭合手术可获得最佳视觉效果。本研究调查了北卡罗来纳州开放性眼球损伤患者在接受手术干预前转至我院与未转至我院的手术时间及视觉效果。
这是一项回顾性队列研究，使用北卡罗来纳大学医院创伤登记处的数据。提取并分析人口统计学资料、受伤时间、最终临床结果、手术干预时间及转运史。研究人群包括2005年至2020年在我院就诊并接受治疗的各年龄段开放性眼球损伤患者。患者根据转运史分组。转运组由从外院转至我院三级医疗设施接受手术治疗的患者组成。非转运组由受伤后直接到达我院三级医疗设施的患者组成。
共评估了238例开放性眼球损伤。其中，197例为转运患者，41例为非转运患者。与非转运患者相比，转运患者在受伤与手术之间、初次急诊就诊与手术之间以及受伤与到达三级医疗中心之间的延迟时间更长。平均而言，转运患者与非转运患者相比，受伤与手术干预之间的延迟时间长3小时51分钟。转运组有8例患者因院际转运延迟>24小时。此外，转运患者的最终视力平均较差，转运组平均最终视力为1.84 logMAR，非转运组为1.35 logMAR。
我们的研究发现，院际转运导致开放性眼球损伤一期闭合手术显著延迟。在接受手术干预前转至三级医疗中心的损伤平均导致更差的最终视力。
