Validation of a new system for triage of ophthalmic emergencies: the alphabetical triage score for ophthalmology (ATSO)
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ORIGINAL PAPER
Validation of a new system for triage of ophthalmic emergencies: the alphabetical triage score for ophthalmology (ATSO) Francesco D’Oria . Marco A. Bordinone . Tiziana Rizzo . Pasquale Puzo . Rosa A. Favale . Silvana Guerriero . Giovanni Alessio
Received: 6 January 2020 / Accepted: 2 May 2020 Springer Nature B.V. 2020
Abstract Purpose To propose a modified ophthalmic triage system based on simple ophthalmic symptoms, signs and anamnestic data and validate its safety and effectiveness. Methods Phase 1 of the study was a retrospective review of chart records of patients admitted at the ophthalmic emergencies room (OER); phase 2 was a prospective study conducted on all consecutive patients presenting in the OER between April 1st, 2018, and May 30th, 2018. We selected the following six factors as predictors of urgency levels: altered vision, ocular behavior, color, distress, eye trauma, floaters and flashes. ATSO final score can be eventually converted into risk groups: low-risk group (scoring 0–3), intermediate-risk group (scoring 4–5) and high-risk group (scoring [ 6). Results A total of 953 consecutive patients who presented to our OER over a two-month period were considered for participation in the study. The male-tofemale ratio was 1.24:1. The mean age of the participants was 53 years (range 18–92, SD 19 years). ATSO score significantly correlated with urgency levels (p \ .00001). The sensitivity of ATSO in
F. D’Oria (&) M. A. Bordinone T. Rizzo P. Puzo R. A. Favale S. Guerriero G. Alessio Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy e-mail: [email protected]
differentiating urgent from non-urgent conditions was 91.4%, and the specificity was 98.2%. All hospitalized patients (30, 3.15%) have been coded as intermediate/high risk according to the ATSO score. Conclusion The use of the ATSO score for patients at the OER provides the clinician with a reliable predictor of urgency, being at the same time safe and effective. The ATSO score may represent a valuable tool to implement triage of ocular patients in the emergency department. Keywords Ocular emergencies Ocular trauma Triage Emergency room
Introduction Ophthalmic emergencies represent a small but significant number of cases presenting to the emergency department (ED) of general hospitals or to the ophthalmic emergency room (OER) of dedicated eye clinics, where they exist. They include pathologies that involve sudden threats to the visual system that left untreated can lead to permanent visual loss or severe threats to the visual function of patients [1]. As highlighted in previous studies [2–4], OER are loaded by patients scattered by the acute presentation of non-urgent ophthalmic conditions. Considering those situations, a reliable ophthalmic triaging system
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could be of great benefit for ED or OER to manage those patients. To data,
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