Oatts Julius T, Xu Albert, Morse Jonathan R, Nesemann John M, Cavuoto Kara M, Keenan Jeremy D
Division of Ophthalmology, Scheie Eye Institute, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
Ophthalmol Sci. 2025 Mar 28;5(5):100776. doi: 10.1016/j.xops.2025.100776. eCollection 2025 Sep-Oct.
There is a shortage of pediatric eye specialists. Inaccessible eye care may lead parents to bring their children to the emergency department (ED) to address eye problems that could have been handled at a clinic visit. This study aimed to determine the association between childhood eye-related ED visits and the location and density of pediatric eye specialists in California.
A population-based cross-sectional study.
All California ED visits between January 2012 and December 2021 for patients ≤18 years of age were identified using the California Office of Health Care Access and Information Database.
International Classification of Diseases diagnosis codes were used to identify eye-related ED visits. Public databases were used to identify pediatric ophthalmologist and optometrist addresses. Census data were used to determine the number of visits per 10 000 children in each zip code. Poisson regressions evaluated associations at the zip code level of eye-related ED visits and provider density with geographic sociodemographic factors.
Incidence of pediatric eye-related ED visits.
Of the 117 363 721 ED visits in California between 2012 and 2021, 27 346 729 (23.3%) were for children, of which 391 985 (1.4%) were eye-related. Median age was 5.0 years (interquartile range: 2.0, 10.0), and 51.7% were male. The most common diagnoses were conjunctivitis (250 028; 63.8%), chalazion/blepharitis (56 389; 14.4%), and other disorders of the eye/adnexa (13 070; 3.3%). The mean number of visits per year per 10 000 children was 43 ± 12 (median 46, interquartile range: 43, 51). The estimated number of pediatric eye providers in California in 2023 was 142 (1 per 61 413 children). Zip codes with more pediatric eye providers had fewer eye-related ED visits: each additional provider per 10 000 children was associated with 2.1 fewer eye-related ED visits per 10 000 children (95% confidence interval -0.04 to -4.25; = 0.046).
Most eye-related ED visits were for nonemergent eye conditions. There was a low eye provider-to-child ratio and an association between provider density and eye-related ED visit incidence. Expanding pediatric eye care could improve access and decrease ED utilization for nonemergent eye concerns.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
儿科眼科专家短缺。难以获得眼科护理可能导致家长带孩子前往急诊科（ED），以解决本可在门诊就诊时处理的眼部问题。本研究旨在确定加利福尼亚州儿童与眼睛相关的急诊科就诊与儿科眼科专家的地点和密度之间的关联。
一项基于人群的横断面研究。
使用加利福尼亚州医疗保健获取和信息办公室数据库，确定2012年1月至2021年12月期间加利福尼亚州所有18岁及以下患者的急诊科就诊情况。
使用国际疾病分类诊断代码来识别与眼睛相关的急诊科就诊。利用公共数据库确定儿科眼科医生和验光师的地址。人口普查数据用于确定每个邮政编码区域每10000名儿童的就诊次数。泊松回归评估了邮政编码区域层面与眼睛相关的急诊科就诊和医疗服务提供者密度与地理社会人口学因素之间的关联。
儿科与眼睛相关的急诊科就诊发生率。
在2012年至2021年期间加利福尼亚州的117363721次急诊科就诊中，27346729次（23.3%）是儿童就诊，其中391985次（1.4%）与眼睛相关。中位年龄为5.0岁（四分位间距：2.0，10.0），男性占51.7%。最常见的诊断为结膜炎（250028例；63.8%）、睑板腺囊肿/睑缘炎（56389例；14.4%）以及其他眼/附属器疾病（13070例；3.3%）。每10000名儿童每年的平均就诊次数为43±12（中位数46，四分位间距：43，51）。2023年加利福尼亚州儿科眼科医疗服务提供者的估计数量为142名（每61413名儿童有1名）。儿科眼科医疗服务提供者较多的邮政编码区域与眼睛相关的急诊科就诊次数较少：每10000名儿童每增加1名医疗服务提供者，每10000名儿童与眼睛相关的急诊科就诊次数就减少2.1次（95%置信区间-0.04至-4.25；P=0.046）。
大多数与眼睛相关的急诊科就诊是针对非紧急眼部疾病。眼科医疗服务提供者与儿童的比例较低，且医疗服务提供者密度与与眼睛相关的急诊科就诊发生率之间存在关联。扩大儿科眼科护理可以改善可及性，并减少因非紧急眼部问题而使用急诊科的情况。
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