CC BY 4.0 · Journal of Academic Ophthalmology 2020; 12(02): e115-e123
DOI: 10.1055/s-0040-1715570
Research Article

The Diagnostic Yield and Cost of Radiologic Imaging for Urgent and Emergent Ocular Conditions in an Eye Emergency Room

1   Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
,
Austin R. Meeker
1   Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
,
Daniel J. Ozzello
1   Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
,
Vishal Swaminathan
1   Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
,
Dilru C. Amarasekera
1   Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
,
Qiang Zhang
2   Biostatistics Consulting Core, Vicky and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, Philadelphia
,
Rose A. Hamershock
2   Biostatistics Consulting Core, Vicky and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, Philadelphia
,
Robert C. Sergott
1   Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
› Author Affiliations
Funding/Support J. D. D. is a 2020–2021 Heed Fellow supported by the Heed Ophthalmic Foundation.

Abstract

Objective The aim of this study is to assess the diagnostic yield and economic cost of radiologic imaging for urgent and emergent ophthalmic conditions in an emergency room (ER) setting

Design Retrospective, consecutive case series.

Methods Charts of all patients who underwent radiologic imaging in a dedicated eye ER over a single year were reviewed. Data collected included age, patient reported chief complaint, visual acuity, principal examination finding, indication for imaging, imaging modalities performed, and the current procedural terminology (CPT) codes billed for the imaging performed. Imaging results were classified into three groups with binary outcomes: normal or abnormal; significant if it led to a change in patient management, and relevant if the imaging findings were related to the chief complaint or principal examination finding. Imaging costs were calculated using the billed CPT codes.

Results A total of 14,961 patients were evaluated during the 1-year study and 1,371 (9.2%) patients underwent imaging. Of these, 521 patients (38.0%) had significant findings. A majority of this group had significant and relevant findings (469, 34.2% of total). Subgroup analysis was performed based upon patient chief complaint, principal examination finding, and indication for imaging. Overall, the total cost of imaging was $656,078.34 with an average cost of $478.54 per patient.

Conclusion Imaging for urgent and emergent ophthalmic conditions in an eye ER resulted in significant management changes in 38.0% of patients. Radiographic imaging contributes to healthcare expenditures; however, these costs must be weighed against the substantial costs of delayed and misdiagnoses, especially when patients present with acute ophthalmological symptoms.

Meeting Presentations

American Academy of Ophthalmology 2019, San Francisco, CA, Podium Presentation.




Publication History

Received: 18 May 2020

Accepted: 07 July 2020

Article published online:
31 August 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 
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