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

Figures & data

Table 1 Vitreoretinal Triage Adopted in Ophthalmic Emergency Care

Category	Symptoms Description and Duration	Triage Plan
VR1	Floaters+/-photopsia without visual Field loss > one month	Refer to GP* with request for referral to outpatient clinic
VR2	Floaters+/-photopsia without visual Filed loss < one month	Appointment in A&E** within one week
VR3	Floaters+/-photopsia with visual field loss	Nil by mouth

Abbreviations: *GP, General practitioner; **A&E, Accident and emergency.

Figure 1 Flow chart showing the existing system for patients with ocular emergencies and the proposed ophthalmic triage implementation.

Table 2 Ocular Emergency Triage System Proposed for Validity Testing

Red (Less Than 10 Minutes)	Green (Less Than 60 Minutes)	Blue (Waiting for Availability)
1.Penetrating injury	1.Corneal abrasion	1.Painless diplopia
2.Chemical burn	2.Corneal /conjunctiva, foreign body	2.Flashes and floaters
3.Headache, sudden loss of visual acuity, elderly, giant cell arthritis	3.Orbital cellulites	3.Recent non-specific blurred vision
4.Painful third cranial nerve palsy, diplopia	4.Infectious conditions, adenovirus	4.Non-specific eye pain
5.Acute glaucoma	5.Corneal ulcer, abscess	5.Conjunctivitis
6.Crying babies with cloudy cornea	6.Welding flash	6.Trichiasis
7.Hypopyon	7.Retinal detachment	7.Cysts (except in children)
8.Severe eye pain	8.Hyphema	8.Phlyctenulosis
9.Intraocular foreign body	9.Recent surgery with complications	9.Blepharitis

Note: White code for none-eye emergencies.

Figure 2 Distribution of ocular emergency patients by ophthalmic subspecialties.

Table 3 Time for Registration, Eye Examination, and Total Time (in Minutes) Spent in the Emergency Unit, as Determined by the Ocular Emergency Triage Coding System

Ocular Emergency Code	Registration Time (Minutes)		Examination Time (Minutes)		Time in Emergency Unit (Minutes)
	Median	Inter Quartile Range	Median	Inter Quartile Range	Median	Inter Quartile Range
Non- emergency (172)	14.9	9.38; 19.53	14.54	10.18; 19.36	1.35	1.0; 2.1
Emergency (353)	14.24	10.13; 18.54	15.4	11.51; 19.51	1.42	0.59; 2.37
Top emergency (465)	15.08	8.56; 19.26	16.30	10.38; 21.05	1.26	0.50; 2.19
	Kruskal Wallis P = 0.018

Table 4 Comparison of Grading Emergency Patients Using Ophthalmic Emergency Triage Coding System and Existing Method of Grading Ocular Emergency

All Emergency Cases (n =1000)		Grading by Using Ophthalmic Emergency Triage Coding System
		None Emergency	Emergency	Top Emergency	Missing	Total
Grading by conventional method	None emergency	172	0	0	0	172
	Emergency	0	214	0	0	214
	Top Emergency	0	139	465	0	604
	Missing	0	0	0	10	10
	Total	172	353	465	10	1000

Table 5 Agreement of Ocular Emergency Grading by Revised Triage and the Existing Method Among Subspecialties of Ophthalmology

Subspecialties	Number of Patients	Agreement Rate	Disagreement Rate	Kappa
Anterior segment	678	85.8	14.2	0.746
Vitreoretinal	108	87	13	0.80
Oculoplastic	37	78.3	21.7	0.595
Uveitis	25	72	28	0.636
Neuro ophthalmology	35	82.9	17.1	0.680
Glaucoma	22	86.4	13.6	0.807
Paediatric ophthalmology	8	100	0	1.0

Table 6 Agreement of Ocular Emergency Grading by Revised Triage and Existing Method for Anterior Segment and Vitreoretinal Subspecialities

Anterior Segment Related Ocular Emergencies (n = 678)		Grading by Using Ophthalmic Emergency Triage Coding System
		Non-Emergency	Emergency	Top Emergency	Total
Grading by conventional method	Non-emergency	89	0	0	89
	Emergency	0	130	0	130
	Top Emergency	0	96	363	459
	Total	89	226	363	678
Vitreoretinal Related Ocular Emergencies (n =108)		Grading by Using Ophthalmic Emergency Triage Coding System
		Non-Emergency	Emergency	Top Emergency	Total
Grading by conventional method	Non-emergency	13	0	0	13
	Emergency	0	39	13	52
	Top Emergency	0	0	43	43