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.