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.
Keywords
diagnostic yield - imaging - cost - economic - emergency room
