Pediatr Emerg Med J.  2024 Jan;11(1):28-38. 10.22470/pemj.2023.00843.

Profile of pediatric ophthalmic referrals in a single emergency department in Korea

• Cha Yh
• Kim JH
• Chung SA

• KMID: 2549538
• DOI: http://doi.org/10.22470/pemj.2023.00843

Abstract

Purpose
This study was performed to examine a comprehensive profile of ophthalmic (OPH) referrals based on diagnosis in a single emergency department (ED) in Korea.
Methods
We analyzed the clinical profiles of children (< 18 years) who underwent immediate OPH referrals in a tertiary hospital ED, from March 2013 through December 2022. Exclusion criteria were a visit related to procedural complication and a discharge before thorough evaluation. We focused on a diagnosis-based high OPH severity requiring emergency surgery or hospitalization. The profiles were compared according to the severity and age group (0-3, 4-6, 7-12, and 13-17 years).
Results
A total of 1,939 children consisted of 1,281 (66.1%) with injury and 658 (33.9%) with non-injury. Top 3 injuries were orbital fracture, hyphema, and corneal abrasion whereas top 3 non-injuries were keratoconjunctivitis, cellulitis, and hordeolum. Children with high OPH severity (54.5%) had significantly lower proportions of girls (26.5% vs. 38.9%), visits on weekend/holiday (34.4% vs. 43.4%), and most non-injury chief complaints, and higher proportions of 13-17 years (41.1% vs. 23.6%), injury (87.7% vs. 40.1%), emergency surgery (4.9% vs. 0.1%), in-ED procedure (9.3% vs. 2.4%), hospitalization (4.0% vs. 0.8%), and most injury mechanisms. With increasing age, high OPH severity, orbital fracture, and hyphema increased in proportions, in contrast to a decreasing tendency in corneal abrasion, keratoconjunctivitis, cellulitis, and hordeolum (all Ps for trend ≤ 0.001). There were 610 (31.5%) children with low OPH severity or no OPH diagnosis.
Conclusion
True OPH emergencies may be more common in injured, older, or male children. This finding could be useful in focusing on emergencies while diverting less urgent cases to outpatient departments or outside ophthalmology clinics.

Keyword

Child; Eye Diseases; Eye Injuries; Ophthalmology; Referral and Consultation

Figure

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  Fig. 1. Flowchart for selection of the study population. The “high,” “medium,” and “low” indicate the OPH severity. *The sum of proportions is not equal to 100% due to rounding. OPH: ophthalmic, ED: emergency department, Dx: diagnosis.

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  Fig. 2. Comparison of high ophthalmic severity and injury and non-injury top 3 diagnoses according to age groups. (A) With increasing age, high severity (shaded bars) and injury (open bars) increase in proportions. (B) Orbital fracture (black shaded bars) and hyphema (open bars) increase with age. This trend contrasts with decreases in corneal abrasion (gray shaded bars), keratoconjunctivitis (stippled bars), cellulitis (fine stippled bars), and hordeolum (hatched bars) (see numerical data in Table 7).

Reference

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