Your browser doesn't support javascript.
loading
Neuro-ophthalmology Emergency Department and Inpatient Consultations at a Large Academic Referral Center.
Okrent Smolar, Avital Lily; Ray, Hetal J; Dattilo, Michael; Bouthour, Walid; Berman, Gabriele; Peragallo, Jason H; Kedar, Sachin; Pendley, Andrew M; Greene, James G; Keadey, Matthew T; Wright, David W; Bruce, Beau B; Newman, Nancy J; Biousse, Valérie.
Afiliação
  • Okrent Smolar AL; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
  • Ray HJ; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
  • Dattilo M; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
  • Bouthour W; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
  • Berman G; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
  • Peragallo JH; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
  • Kedar S; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.
  • Pendley AM; Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia.
  • Greene JG; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.
  • Keadey MT; Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia.
  • Wright DW; Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia.
  • Bruce BB; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
  • Newman NJ; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia; Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia.
  • Biousse V; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia. Electronic address: vbiouss@emory.edu.
Ophthalmology ; 130(12): 1304-1312, 2023 Dec.
Article em En | MEDLINE | ID: mdl-37544433
PURPOSE: Prompt neuro-ophthalmology consultation prevents diagnostic errors and improves patient outcomes. The scarcity of neuro-ophthalmologists means that the increasing outpatient demand cannot be met, prompting many emergency department (ED) referrals by non-neuro-ophthalmologists. We describe our quaternary care institution's ED and inpatient neuro-ophthalmology consultation patterns and patient outcomes. DESIGN: Prospective observational study. PARTICIPANTS: Consecutive neuro-ophthalmology ED and inpatient consultation requests over 1 year. METHODS: We collected patient demographics, distance traveled, insurance status, referring provider details, consultation question, final diagnosis, complexity of consultation, time of consultation, and need for outpatient follow-up. MAIN OUTCOME MEASURES: Consultation patterns and diagnoses, complexity, and follow-up. RESULTS: Of 494 consecutive adult ED and inpatient neuro-ophthalmology consultations requested over 1 year, 241 of 494 consultations (49%) occurred at night or during weekends. Of ED consultations (322 of 494 [65%]), 127 of 322 consultations (39%) occurred during weekdays, 126 of 322 consultations (39%) occurred on weeknights, and 69 of 322 consultations (22%) occurred on weekends or holidays. Of 322 ED consultations, 225 of 322 consultations (70%) were patients who initially sought treatment in the ED with a neuro-ophthalmic chief symptom. Of the 196 patients sent to the ED by a health care professional, 148 patients (148/196 [76%]) were referred by eye care specialists (74 optometrists and 74 ophthalmologists). The most common ED referral questions were for papilledema (75 of 322 [23%]) and vision loss (72 of 322 [22%]). A total of 219 of 322 patients (68%) received a final active neuro-ophthalmic diagnosis, 222 of 322 patients (69%) were cases of high or very high complexity, and 143 of 322 patients (44%) required admission. Inpatient consultations (n = 172) were requested most frequently by hospitalists, including neurologists (71 of 172 [41%]) and oncologists (20 of 172 [12%]) for vision loss (43 of 172 [25%]) and eye movement disorders (36 of 172 [21%]) and by neurosurgeons (58 of 172 [33%]) for examination for mass or a preoperative evaluation (19 of 172 [11%]). An active neuro-ophthalmic diagnosis was confirmed in 67% of patients (116 of 172). Outpatient neuro-ophthalmology follow-up was required for 291 of 494 patients (59%). CONCLUSIONS: Neuro-ophthalmology consultations are critical to the diagnosis and management in the hospital setting. In the face of a critical shortage of neuro-ophthalmologists, this study highlights the need for technological and diagnostic aids for greater outpatient access. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Assuntos
Palavras-chave

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Oftalmologia / Neurologia Tipo de estudo: Observational_studies Limite: Adult / Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Oftalmologia / Neurologia Tipo de estudo: Observational_studies Limite: Adult / Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article