Chen Juan, Chen Chen-Mei, Zheng Yongxin, Zhong Liuxueying
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China.
Front Med (Lausanne). 2023 Mar 16;10:1091128. doi: 10.3389/fmed.2023.1091128. eCollection 2023.
To describe characteristics of eye-related emergency department (ED) visits and investigate differences in priorities assigned to patients by triage nurses and ophthalmologists.
A prospective survey was conducted at the ED of Zhongshan Ophthalmic Center from January 1, 2021, to May 31, 2021. Clinical data from patients with acute ophthalmic conditions lasting less than 7 days were collected a standard questionnaire and the urgency levels assigned by nurses and physicians were also recorded. Binary logistic regression was performed to identify characteristics associated with truly emergency conditions and up- or down-triage.
A total of 1907 patients were enrolled, with 582 (30.5%) classified as "non-emergency." Red eye (69.7%), eye pain (53.0%), ocular trauma (44.1%), tearing (43.6%), and blurred vision (43.1%) were the most common complaints. Truly emergency tended to be male (OR 2.019, < 0.001) and with unilateral eye involvement (OR 2.992, < 0.001). Nurses prioritized conjunctival, scleral, closed ocular trauma and eyelid diseases over doctors while giving less priority to open ocular trauma, cornea, uveitis, and vitreoretinal diseases ( < 0.05). Overemphasis on mild blurred vision (OR 3.718, = 0.001) and insufficient understanding of conjunctival diseases without red eye (OR 0.254, = 0.001) were associated with conjunctival disease "up-triage." Insufficient awareness of moderate and severe blurred vision was associated with "down-triage" for ocular trauma (OR 3.475, = 0.001 and OR 2.422, = 0.020, respectively).
Ophthalmic EDs are typically flooded with patients suffering from acute ocular problems, with a considerable portion for non-emergency conditions. The identification of characteristics associated with truly emergency cases and nurses' triage preferences is valuable in providing target guidance for future ED practice and facilitating the proper allocation of emergency resources.
描述眼科急诊就诊的特征，并调查分诊护士和眼科医生对患者优先级分配的差异。
于2021年1月1日至2021年5月31日在中山大学中山眼科中心急诊科进行前瞻性调查。收集急性眼科疾病持续时间少于7天的患者的临床资料，采用标准问卷，并记录护士和医生分配的紧急程度。进行二元逻辑回归分析，以确定与真正紧急情况及分诊上调或下调相关的特征。
共纳入1907例患者，其中582例（30.5%）被归类为“非紧急情况”。眼红（69.7%）、眼痛（53.0%）、眼外伤（44.1%）、流泪（43.6%）和视力模糊（43.1%）是最常见的主诉。真正的紧急情况往往为男性（比值比[OR]2.019，P<0.001）且单眼受累（OR 2.992，P<0.001）。护士对结膜、巩膜、闭合性眼外伤和眼睑疾病的优先级高于医生，而对开放性眼外伤、角膜、葡萄膜炎和玻璃体视网膜疾病的优先级较低（P<0.05）。对轻度视力模糊的过度重视（OR 3.718，P=0.001）以及对无眼红的结膜疾病认识不足（OR 0.254，P=0.001）与结膜疾病“分诊上调”相关。对中度和重度视力模糊认识不足与眼外伤“分诊下调”相关（分别为OR 3.475，P=0.001和OR 2.422，P=0.020）。
眼科急诊科通常挤满了患有急性眼部问题的患者，其中相当一部分为非紧急情况。识别与真正紧急病例相关的特征以及护士的分诊偏好，对于为未来急诊科实践提供目标指导和促进紧急资源的合理分配具有重要价值。
