A survey of the ophthalmic presentations and their outcomes to a general hospital Emergency Department over twelve months

Rabin Bhandari & Brendon Smith


Dr. Rabin Bhandari
BMed, University of Newcastle (2007)
Registrar, Prince of Wales Hospital

Dr. Brendon Smith
Staff Specialist
Sydney South West Area Health Service

Dr. Bhandari undertook this research as a final year medical student in 2007. He worked as an intern and then resident at Bankstown and Campbelltown hospitals in 2008 and 2009 respectively. He is currently a registrar in Rehabilitation Medicine.

After graduation, Dr. Smith undertook further training in Emergency Medicine and related fields. He is a fellow of the college of Emergency Medicine and is a staff specialist Emergency Physician.


Abstract

Aim: To survey the diagnoses and discharge status of the ophthalmic presentations to a general emergency department (ED). To compare the ED diagnosis with the ophthalmologist diagnosis of referred patients. Methods: A retrospective analysis of all the ophthalmic presentations to the Gosford District Hospital from 1 January 2005 to 31 December 2005 was carried out. All referrals to and admissions by ophthalmologists were reviewed for the final diagnosis. These outcomes were compared to the initial ED diagnosis. Results: There were 509 ophthalmic presentations to the ED in 2005: 51% had corneal trauma, 14% had an unspecified red or painful eye, 9% had an unspecified eye injury and 5% had blurred vision. Most patients were discharged without referral. Twenty-two percent of patients were referred to an ophthalmologist. Four percent were admitted and transferred to Sydney Eye Hospital. In those who were referred, 13% did not have records at the specified ophthalmologist, 24% were not recorded to which specialist they were referred and 26% had significantly different specialist opinion. Conclusions: More than half of ED ophthalmic presentations were for corneal trauma and only 22% of patients were referred to an ophthalmologist, while most were treated solely in the ED or referred to general practice. Potentially vision-threatening misdiagnoses included three cases of iritis, three of keratitis and two of retinal artery occlusion. ED diagnoses of corneal problems matched exactly with ophthalmic opinion. Interestingly, recording of the visual acuity occurred in only 27% of cases.