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Original Investigation |

Epidemiology of Eye-Related Emergency Department Visits

Roomasa Channa, MD1; Syed Nabeel Zafar, MBBS, MPH2; Joseph K. Canner, MHS3; R. Sterling Haring, DO, MPH4; Eric B. Schneider, PhD3,4,5,6; David S. Friedman, MD, MPH, PhD1,5
[+] Author Affiliations
1Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland
2Department of Surgery, Howard University Hospital, Washington, DC
3Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
4Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachussets
5Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
6Harvard Medical School, Boston, Massachussets
JAMA Ophthalmol. 2016;134(3):312-319. doi:10.1001/jamaophthalmol.2015.5778.
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Importance  Determining the epidemiology of eye-related emergency department (ED) visits on a national level can assist policymakers in appropriate allocation of resources.

Objective  To study ED visits related to ocular conditions for all age groups across the United States.

Design, Setting, and Participants  Nationally representative data from the US Nationwide Emergency Department Sample (NEDS) were used to analyze ED visits from January 1, 2006, to December 31, 2011 (6 years). All patients with eye problems presenting to EDs across the United States were eligible for inclusion. A weighted count of 11 929 955 ED visits were categorized as possibly emergent (emergent), unlikely to be emergent (nonemergent), or could not be determined. Data were analyzed from March 1 to May 30, 2015.

Main Outcomes and Measures  Population-based incidence rates of eye-related ED visits, incidence rates of eye injuries, relative proportions of emergent vs nonemergent eye-related ED visits among different age groups, and independent factors associated with emergent vs nonemergent visits.

Results  From 2006 to 2011, 11 929 955 ED visits (male patients, 54.2%; mean [SD] age, 31 [22] years) for ocular problems across the United States were categorized as emergent (41.2%), nonemergent (44.3%), or could not determine (14.5%). Corneal abrasions (13.7%) and foreign body in the external eye (7.5%) were the leading diagnoses in the emergent category. More than 4 million visits were for conjunctivitis (28.0%), subconjunctival hemorrhages (3.0%), and styes (3.8%). Emergent visits were significantly more likely to occur among males (odds ratio [OR], 2.00; 95% CI, 2.00-2.01), patients in the highest income quartile (OR, 1.47; 95% CI, 1.46-1.49), older patients (OR, 2.38; 95% CI, 2.38-2.44), and patients with private insurance (OR, 1.29; 95% CI, 1.28-1.30). Mean annual inflation-adjusted charges for all eye-related ED visits totaled $2.0 billion.

Conclusions and Relevance  Across the United States, nonemergent conditions accounted for almost half of all eye-related ED visits. Interventions to facilitate management of these cases outside the ED could make ED resources more available for truly emergent ophthalmic and medical issues.

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Figure 1.
Leading Diagnoses in the Emergency Department (ED), 2006-2011

Visits and diagnoses were categorized as emergent, nonemergent, and not determined by diagnostic codes. Weights provided by the Healthcare Cost and Utilization Project were applied to obtain national estimates.

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Figure 2.
Mean Charges per Emergency Department (ED) Visit

The change over time is given in mean inflation-adjusted charges (US dollars) per visit for emergent and nonemergent eye-related ED visits.

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