Clinical findings provide criteria to evaluate priorities of ophthalmologic intervention in conscious multiple trauma patients

Injury. 2015 Jul;46(7):1238-40. doi: 10.1016/j.injury.2014.10.056. Epub 2014 Oct 31.

Abstract

Introduction: Multiple trauma patients frequently suffer eye injuries, especially those patients with head traumas. We evaluated the accuracy of physical findings to determine the priorities of emergency ophthalmologic intervention in these patients.

Patients and methods: This study included all multiple trauma patients with ophthalmic trauma who had a GCS of 15 when they arrived at the emergency department during the period of March, 2008-March, 2009. First, we evaluated the patients according to the criteria of the study. Then, an ophthalmologist evaluated them.

Result: From March 2008-March 2009, 306 multiple trauma patients with ocular trauma came to our ED. The sensitivity and accuracy of emergency physicians in diagnosing the priority of ophthalmologic treatment were comparable to an ophthalmologist (measure of agreement in kappa=0.967).

Discussion: The ability of an emergency physician or general surgeon to determine the actual need of early ophthalmologist intervention can improve decision making and saving both time and money. Our study suggests that it is possible to determine according to clinical findings the need of the patient to have ophthalmologic intervention without referring the patient to ophthalmologist examination.

Conclusion: Defining specific criteria of ophthalmologic examinations can clarify the necessity of emergency ophthalmologic examination and intervention.

Keywords: Criteria; Eye emergency; Multiple trauma.

MeSH terms

  • Adult
  • Clinical Protocols
  • Consciousness
  • Decision Making
  • Diagnostic Techniques, Ophthalmological*
  • Emergency Medicine / organization & administration*
  • Emergency Service, Hospital
  • Eye Injuries / diagnosis*
  • Eye Injuries / physiopathology
  • Eye Injuries / therapy
  • Female
  • Glasgow Coma Scale
  • Humans
  • Iran / epidemiology
  • Male
  • Multiple Trauma / complications*
  • Multiple Trauma / physiopathology
  • Multiple Trauma / therapy
  • Optic Nerve Injuries / diagnosis*
  • Optic Nerve Injuries / physiopathology
  • Optic Nerve Injuries / therapy
  • Orbital Fractures / diagnosis*
  • Orbital Fractures / physiopathology
  • Orbital Fractures / therapy
  • Physical Examination / methods*
  • Time-to-Treatment
  • Trauma Severity Indices