Quintero Michael, Mahjoub Heba, Ssekasanvu Joseph, Yonekawa Yoshihiro, Justin Grant A, Cavuoto Kara M, Lorch Alice, Madan Vrinda, Sivakumar Ishu, Zhao Xiyu, Simeon Olivia Febles, Salabati Mirataollah, Wu Connie M, Woreta Fasika A
From the Johns Hopkins University School of Medicine (M.Q., V.M., I.S., X.Z., O.F.S.), Baltimore, Maryland.
Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Tufts University School of Medicine (H.M.), Boston, Massachusetts.
Am J Ophthalmol. 2025 Jan;269:84-93. doi: 10.1016/j.ajo.2024.06.031. Epub 2024 Jul 6.
To compare sociodemographic factors in patients presenting to the emergency department (ED) with emergent and nonemergent eye-related concerns.
Cross-sectional multicenter study.
60,677 patients with eye-related concerns who visited EDs at Bascom Palmer Eye Institute, Wills Eye Hospital, Massachusetts Eye and Ear, and Johns Hopkins Hospital/Wilmer Eye Institute from January 1, 2019, until December 31, 2019.
Descriptive statistics were performed using Stata, version 17.
(1) Sociodemographic factors associated with emergent diagnoses, (2) visit patterns across ED settings (ie, standard ED vs eye ED), and (3) the most common emergent and nonemergent diagnoses.
A total of 60,677 eye-related ED encounters were included in the study, including 22,434 at Bascom Palmer Eye Institute, 16,124 at Wills Eye Hospital, 15,487 at Massachusetts Eye and Ear, and 6632 at Johns Hopkins Hospital/Wilmer Eye Institute. Most patients had nonemergent diagnoses (56.7%). Males (odds ratio [OR] 1.85, 95% CI 1.79-1.92) were more likely to have an emergent diagnosis than females. Patients with private or employer-based insurance (OR 0.88, 95% CI 0.81-0.96), Medicare (OR 0.80, 95% CI 0.72-0.87), and Medicaid (OR 0.81, 95% CI 0.74-0.89) were all less likely to have an emergent diagnosis than uninsured patients. Those with Veteran or military insurance (OR 1.08, 95% CI 0.87-1.34) were equally likely to have an emergent diagnosis compared with uninsured patients. Non-White Hispanic patients (OR 1.26, 95% CI 1.12-1.42) were more likely to present with an emergent condition than White patients. Patients seen in the standard ED setting were more likely to have emergent diagnoses than those who visited standalone eye EDs (P < .001). The most common emergent diagnoses were corneal abrasion (12.97%), extraocular foreign body (7.61%), and corneal ulcer (7.06%). The most common nonemergent diagnoses were dry eye (7.90%), posterior vitreous detachment (7.76%), and chalazion (6.57%).
ED setting was associated with the acuity of patient diagnoses. Lack of insurance coverage and non-White Hispanic race or ethnicity were associated with emergent eye-related ED visits. Improving access to ophthalmic care in these populations may reduce the incidence of preventable eye emergencies related to untreated chronic conditions. This combined with measures to redirect nonemergent issues to outpatient clinics may alleviate ED overload.
比较因紧急和非紧急眼部相关问题前往急诊科（ED）就诊患者的社会人口学因素。
横断面多中心研究。
2019年1月1日至2019年12月31日期间在巴斯科姆·帕尔默眼科研究所、威尔斯眼科医院、马萨诸塞州眼耳医院以及约翰·霍普金斯医院/威尔默眼科研究所急诊科就诊的60677名有眼部相关问题的患者。
使用Stata 17版进行描述性统计。
（1）与紧急诊断相关的社会人口学因素；（2）不同急诊科环境下的就诊模式（即标准急诊科与眼科急诊科）；（3）最常见的紧急和非紧急诊断。
本研究共纳入60677次与眼部相关的急诊科就诊病例，其中巴斯科姆·帕尔默眼科研究所22434例，威尔斯眼科医院16124例，马萨诸塞州眼耳医院15487例，约翰·霍普金斯医院/威尔默眼科研究所6632例。大多数患者为非紧急诊断（56.7%）。男性（优势比[OR]1.85，95%置信区间1.79 - 1.92）比女性更有可能有紧急诊断。拥有私人保险或雇主提供保险的患者（OR 0.88，95%置信区间0.81 - 0.96）、医疗保险患者（OR 0.80，95%置信区间0.72 - 0.87）以及医疗补助患者（OR 0.81，95%置信区间0.74 - 0.89）比未参保患者有紧急诊断的可能性均更低。有退伍军人或军事保险的患者（OR 1.08，95%置信区间0.87 - 1.34）与未参保患者有紧急诊断的可能性相同。非白人西班牙裔患者（OR 1.26，95%置信区间1.12 - 1.42）比白人患者更有可能出现紧急情况。在标准急诊科环境下就诊的患者比在独立眼科急诊科就诊的患者更有可能有紧急诊断（P < 0.001）。最常见的紧急诊断为角膜擦伤（12.97%）、眼外异物（7.61%）和角膜溃疡（7.06%）。最常见的非紧急诊断为干眼症（7.90%）、玻璃体后脱离（7.76%）和睑板腺囊肿（6.57%）。
急诊科环境与患者诊断的紧急程度相关。缺乏保险覆盖以及非白人西班牙裔种族或族裔与紧急眼部相关的急诊科就诊有关。改善这些人群获得眼科护理的机会可能会降低与未治疗的慢性病相关的可预防眼部紧急情况的发生率。这与将非紧急问题引导至门诊诊所的措施相结合，可能会缓解急诊科的负担过重问题。
