Validity of an Ocular Emergency Triage System Compared to the Existing Grading System at the Emergency Unit of a Tertiary Eye Hospital in Saudi Arabia

Abstract

Purpose

To assess true ocular emergencies based on the ocular emergency triage system compared to the existing method of serving patients “first come first serve” by attending ophthalmology resident and review the validity of the triage system by ophthalmic subspecialty.

Methods

In this cross-sectional study of validity, new patients attending the ocular emergency department of a tertiary eye hospital in 2021–2022 were examined by ophthalmology resident. The time required for registration, an eye exam, and total time in the emergency unit was determined. Using ophthalmic triage criteria, same patients were reviewed by senior ophthalmologist to categorize them as “top emergencies”, “emergencies”, and “not an emergency.” The reviewer was masked about grading by an ophthalmology resident. The agreement rate for true emergencies by both methods of grading was calculated by subspecialty.

Results

One thousand patients with ocular emergencies were evaluated. The median overall time spent in the emergency unit was 92 minutes [interquartile range (IQR): 56; 142]. The revised triage system estimated 85% were “true emergencies.” Using both the revised triage and conventional methods, 172 (17.2%) patients were not considered as having an ocular emergency. The difference in patients grouped into “emergencies” (34.3% vs 21.4%) and “top emergencies” (46.5% vs 60.4%) was significant (P<0.001) between methods. Uveitis (72%) had the lowest agreement between methods and pediatric ophthalmology (100%) had the highest agreement.

Conclusion

The revised ophthalmic triage system seems to be more efficient than existing method. Subspecialist ophthalmologists may provide quicker and better treatment if ophthalmic emergency patients are prioritized utilizing the proposed redesigned triage method.

Keywords:

• emergency
• eye
• ophthalmic
• triage

Ethical Statement

The study was authorized by the King Khaled Eye Specialist Hospital’s Institutional Review Board and followed the Helsinki Declaration’s tenets. All participants/guardians have provided written informed consent to participate in this study.

Acknowledgment

We would like to thank the research coordinator Mr Faisal Al Hamidi for his help in this study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.