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Enhancing Ophthalmic Triage: identification of new clinical features to support healthcare professionals in triage

Eye (2024)Cite this article

Subjects

Abstract

Objective

To investigate which features from a patient’s history are either high or low risk that could support healthcare professionals in ophthalmic emergency triage.

Methods

Prospective, 12,584 visits from 11,733 adult patients attending an Accident and Emergency department at a single tertiary centre were analysed. Data were collected by ophthalmic nurses working in triage, using an online form from August 2021 to April 2022. Multivariate analysis (MVA) was conducted to identify which features from the patients’ history would be associated with emergency care.

Results

This study found that 45.5% (5731 patient visits (PV)) required a same day eye emergency examination (SDEE), 11.3% (1416 PV) needed urgent care, and 43.2% (5437 PV) were appropriate for elective consultations with a GP or optometrist. The MVA top ten features that were statistically significant (p < 0.05) that would warrant SDEE with odds ratio (95% CI) were: bilateral eye injury 36.5 [15.6–85.5], unilateral eye injury 25.8 [20.9–31.7], vision loss 4.8 [2.9–7.8], post-operative ophthalmic ( < 4 weeks) 4.6 [3.8–5.7], contact lens wearer 3.9 [3.3–4.7], history of uveitis 3.9 [3.3–4.7], photophobia 2.9 [2.4–3.6], unilateral dark shadow/curtain in vision 2.4 [1.8–3.0], unilateral injected red eye 2.0 [1.8–2.2] and rapid change in visual acuity 1.8 [1.5–2.2].

Conclusion

This study characterises presenting features covering almost 100 ophthalmic acute presentations that are commonly seen in emergency and elective care. This information could supplement current red flag indicators and support healthcare professionals in ophthalmic triage. Further research is required to evaluate the cost effectivity and safety of our findings for triaging acute presentations.

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Acknowledgements

We would like to thank all triage nurses at the Accident and Emergency Department at Moorfields Eye Hospital NHS Foundation Trust, London, UK for collecting the data. In addition, we would like to thank the Moorfields IT team and patients on the study Lay Advisory Panel for their feedback on the study.

Funding

This work was supported by the Artificial Intelligence in Health and Care Award (AI_AWARD01671) of the NHS AI Lab under the National Institute for Health and Care Research (NIHR) and the Accelerated Access Collaborative (AAC).

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Authors and Affiliations

  1. Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom

    Anish Jindal, Yan Ning Neo & Alexander C. Day

  2. Department of Brain Sciences, Institute of Ophthalmology, University College London, London, UK

    Anish Jindal, Camilo Brandao-de-Resende & Alexander C. Day

  3. NIHR Moorfields Clinical Research Facility, Moorfields Eye Hospital, London, United Kingdom

    Camilo Brandao-de-Resende, Mariane Melo & Alexander C. Day

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  1. Anish Jindal
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Contributions

Contributors: AJ, CBR, YNN, MM and ACD. Study Conception: MM and ACD. MM and ACD were involved in the funding acquisition and project administration. Data collection: All authors. Data validation: AJ, CBR, YNN. Analysis: CBR. Manuscript preparation: AJ and YNN. All authors read, commented and approved the final manuscript.

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Correspondence to Anish Jindal.

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Competing interests

CBR and MM work for DemDX Ltd. CBR, MM, AJ, YNN, and ACD were funded by the National Institute for Health and Care Research (NIHR) artificial intelligence (AI) Award to work on this study.

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Jindal, A., Brandao-de-Resende, C., Neo, Y.N. et al. Enhancing Ophthalmic Triage: identification of new clinical features to support healthcare professionals in triage. Eye (2024). https://doi.org/10.1038/s41433-024-03070-9

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