Retrospective Optimization of the Hawkeye Orbital Fracture Prioritization and Evaluation Algorithms for Triaging Ophthalmic Care
Objectives: Many orbital fracture patients are transferred to tertiary care centers for immediate ophthalmology consultation, though few require urgent ophthalmic evaluation or intervention. This overutilizes limited resources and overburdens patients and the health care system with travel and emerg...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-05-01
|
| Series: | Ophthalmology Science |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666914523001793 |
| _version_ | 1797349427668582400 |
|---|---|
| author | Peter H. Sanchez Erin M. Shriver, MD Margaret R. Strampe, MD Ryan J. Diel, MD Chau M. Pham, MD Keith D. Carter, MD Pavlina S. Kemp, MD Matthew G. Field, MD, PhD |
| author_facet | Peter H. Sanchez Erin M. Shriver, MD Margaret R. Strampe, MD Ryan J. Diel, MD Chau M. Pham, MD Keith D. Carter, MD Pavlina S. Kemp, MD Matthew G. Field, MD, PhD |
| author_sort | Peter H. Sanchez |
| collection | DOAJ |
| description | Objectives: Many orbital fracture patients are transferred to tertiary care centers for immediate ophthalmology consultation, though few require urgent ophthalmic evaluation or intervention. This overutilizes limited resources and overburdens patients and the health care system with travel and emergency department (ED) expenses. A simple, easy-to-use, clinical decision-making tool is needed to aid local EDs and triage services in effectively identifying orbital fracture patients who need urgent ophthalmic evaluation. Design: Single center, retrospective cohort study. Subjects: Orbital fracture patients aged ≥ 18 years who presented to the study institution’s emergency department and received an ophthalmology consultation. Methods: Ocular injuries that required close monitoring or an intervention within the first few hours after presentation were termed urgent. Two Hawkeye Orbital Fracture Prioritization and Evaluation (HOPE) algorithms were developed to identify orbital fracture patients needing urgent evaluation; including 1 algorithm incorporating computerized tomography (CT) scans interpreted by ophthalmology (HOPE+CT). Algorithms were compared with 3 previously published protocols: the University of Texas Health Science Center at Houston (UTH), the South Texas Orbital Fracture Protocol (STOP), and Massachusetts Eye and Ear (MEE) algorithms. Main Outcome Measures: Correct triage of patients with orbital fractures who have urgent ocular or orbital conditions. Results: In the study institution’s ED, 134 adult patients (145 orbits) were seen with orbital fractures in 2019. Eighteen (13.4%) had ocular or orbital conditions categorized as urgent. The HOPE tool resulted in 100% sensitivity and 78.4% specificity. The HOPE+CT tool resulted in 100.0% sensitivity and 94.0% specificity. The UTH algorithm was 91.7% sensitive and 76.5% specific. South Texas Orbital Fracture Protocol and MEE were both 100% sensitive but only 35.1% and 32.8% specific, respectively. Conclusions: The HOPE and HOPE+CT algorithms were superior or equal to the UTH, STOP, and MEE algorithms in terms of specificity while detecting all urgent cases. Implementation of a triage protocol that uses the HOPE or HOPE+CT algorithms could improve resource utilization and reduce health care costs through identification of orbital fracture patients needing urgent evaluation. An online tool that deploys the HOPE+CT algorithm in a user-friendly interface has been developed and is undergoing prospective validation before public dissemination. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. |
| first_indexed | 2024-03-08T12:30:05Z |
| format | Article |
| id | doaj.art-4cc264dd2f3a44909491414d7d261f91 |
| institution | Directory Open Access Journal |
| issn | 2666-9145 |
| language | English |
| last_indexed | 2024-03-08T12:30:05Z |
| publishDate | 2024-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Ophthalmology Science |
| spelling | doaj.art-4cc264dd2f3a44909491414d7d261f912024-01-22T04:16:14ZengElsevierOphthalmology Science2666-91452024-05-0143100447Retrospective Optimization of the Hawkeye Orbital Fracture Prioritization and Evaluation Algorithms for Triaging Ophthalmic CarePeter H. Sanchez0Erin M. Shriver, MD1Margaret R. Strampe, MD2Ryan J. Diel, MD3Chau M. Pham, MD4Keith D. Carter, MD5Pavlina S. Kemp, MD6Matthew G. Field, MD, PhD7Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IowaDepartment of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa; Department of Otolaryngology–Head and Neck Surgery, Carver College of Medicine, University of Iowa, Iowa City, IowaDepartment of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IowaDepartment of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IowaDepartment of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IowaDepartment of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa; Department of Otolaryngology–Head and Neck Surgery, Carver College of Medicine, University of Iowa, Iowa City, IowaDepartment of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IowaDepartment of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa; Minnesota Eye Consultants, Bloomington, Minnesota; Correspondence: Matthew G. Field, MD, PhD, Department of Ophthalmology and Visual Sciences, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242.Objectives: Many orbital fracture patients are transferred to tertiary care centers for immediate ophthalmology consultation, though few require urgent ophthalmic evaluation or intervention. This overutilizes limited resources and overburdens patients and the health care system with travel and emergency department (ED) expenses. A simple, easy-to-use, clinical decision-making tool is needed to aid local EDs and triage services in effectively identifying orbital fracture patients who need urgent ophthalmic evaluation. Design: Single center, retrospective cohort study. Subjects: Orbital fracture patients aged ≥ 18 years who presented to the study institution’s emergency department and received an ophthalmology consultation. Methods: Ocular injuries that required close monitoring or an intervention within the first few hours after presentation were termed urgent. Two Hawkeye Orbital Fracture Prioritization and Evaluation (HOPE) algorithms were developed to identify orbital fracture patients needing urgent evaluation; including 1 algorithm incorporating computerized tomography (CT) scans interpreted by ophthalmology (HOPE+CT). Algorithms were compared with 3 previously published protocols: the University of Texas Health Science Center at Houston (UTH), the South Texas Orbital Fracture Protocol (STOP), and Massachusetts Eye and Ear (MEE) algorithms. Main Outcome Measures: Correct triage of patients with orbital fractures who have urgent ocular or orbital conditions. Results: In the study institution’s ED, 134 adult patients (145 orbits) were seen with orbital fractures in 2019. Eighteen (13.4%) had ocular or orbital conditions categorized as urgent. The HOPE tool resulted in 100% sensitivity and 78.4% specificity. The HOPE+CT tool resulted in 100.0% sensitivity and 94.0% specificity. The UTH algorithm was 91.7% sensitive and 76.5% specific. South Texas Orbital Fracture Protocol and MEE were both 100% sensitive but only 35.1% and 32.8% specific, respectively. Conclusions: The HOPE and HOPE+CT algorithms were superior or equal to the UTH, STOP, and MEE algorithms in terms of specificity while detecting all urgent cases. Implementation of a triage protocol that uses the HOPE or HOPE+CT algorithms could improve resource utilization and reduce health care costs through identification of orbital fracture patients needing urgent evaluation. An online tool that deploys the HOPE+CT algorithm in a user-friendly interface has been developed and is undergoing prospective validation before public dissemination. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.http://www.sciencedirect.com/science/article/pii/S2666914523001793Orbital fractureTraumaOcular injury |
| spellingShingle | Peter H. Sanchez Erin M. Shriver, MD Margaret R. Strampe, MD Ryan J. Diel, MD Chau M. Pham, MD Keith D. Carter, MD Pavlina S. Kemp, MD Matthew G. Field, MD, PhD Retrospective Optimization of the Hawkeye Orbital Fracture Prioritization and Evaluation Algorithms for Triaging Ophthalmic Care Ophthalmology Science Orbital fracture Trauma Ocular injury |
| title | Retrospective Optimization of the Hawkeye Orbital Fracture Prioritization and Evaluation Algorithms for Triaging Ophthalmic Care |
| title_full | Retrospective Optimization of the Hawkeye Orbital Fracture Prioritization and Evaluation Algorithms for Triaging Ophthalmic Care |
| title_fullStr | Retrospective Optimization of the Hawkeye Orbital Fracture Prioritization and Evaluation Algorithms for Triaging Ophthalmic Care |
| title_full_unstemmed | Retrospective Optimization of the Hawkeye Orbital Fracture Prioritization and Evaluation Algorithms for Triaging Ophthalmic Care |
| title_short | Retrospective Optimization of the Hawkeye Orbital Fracture Prioritization and Evaluation Algorithms for Triaging Ophthalmic Care |
| title_sort | retrospective optimization of the hawkeye orbital fracture prioritization and evaluation algorithms for triaging ophthalmic care |
| topic | Orbital fracture Trauma Ocular injury |
| url | http://www.sciencedirect.com/science/article/pii/S2666914523001793 |
| work_keys_str_mv | AT peterhsanchez retrospectiveoptimizationofthehawkeyeorbitalfractureprioritizationandevaluationalgorithmsfortriagingophthalmiccare AT erinmshrivermd retrospectiveoptimizationofthehawkeyeorbitalfractureprioritizationandevaluationalgorithmsfortriagingophthalmiccare AT margaretrstrampemd retrospectiveoptimizationofthehawkeyeorbitalfractureprioritizationandevaluationalgorithmsfortriagingophthalmiccare AT ryanjdielmd retrospectiveoptimizationofthehawkeyeorbitalfractureprioritizationandevaluationalgorithmsfortriagingophthalmiccare AT chaumphammd retrospectiveoptimizationofthehawkeyeorbitalfractureprioritizationandevaluationalgorithmsfortriagingophthalmiccare AT keithdcartermd retrospectiveoptimizationofthehawkeyeorbitalfractureprioritizationandevaluationalgorithmsfortriagingophthalmiccare AT pavlinaskempmd retrospectiveoptimizationofthehawkeyeorbitalfractureprioritizationandevaluationalgorithmsfortriagingophthalmiccare AT matthewgfieldmdphd retrospectiveoptimizationofthehawkeyeorbitalfractureprioritizationandevaluationalgorithmsfortriagingophthalmiccare |