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Patients downplay severity of ocular emergencies in French hospital study

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Patients presenting for ocular emergencies at a French public hospital tended to underestimate the severity of their condition, a fact which medical staff should bear in mind in the triage of such cases, according to Aurelie Pison FEBO.

“Ophthalmic emergency triage is essential for prompt recognition of urgent cases. However, the concept of severity is broad and tends to be interpreted differently by physicians and patients. Our study, comparing the subjective severity perceived by patients and the objective evaluation of physicians showed that patients had a clear tendency towards underestimating the severity of their condition,” she told the delegates attending the annual meeting of the French Society of Ophthalmology (SFO).

Dr Pison’s study was carried out over a two-month period: July and October 2013 at the Hôtel-Dieu Cochin Hospital in Paris. Of a total of 4,400 ocular emergencies that presented at the hospital during that period, 1,429 were excluded from the study for various reasons. The average age of the patients was 43.23 years (+/-19).

In addition to evaluation by triage staff and patient self-assessment, patients were allocated a pain classification score, with pain graded on a scale from one to 10. Patients’ behaviour was also rated from zero (normal) to five (violent or highly incoherent). After examination, an objective severity score was allocated by the ophthalmologist.

The results showed that more than half of the patients (56 per cent) displayed normal behaviour (score zero), and no patient scored five. Dr Pison noted the difficulty that many patients experienced in self-evaluating the severity of their condition, with 18 per cent finding it impossible to allocate a score to their condition.

In terms of objective severity, the condition of patients was deemed to be normal or sub-normal in 25 per cent, of moderate severity in 40 per cent and serious or maximal in 35 per cent. For subjective severity, one-third of patients considered their condition as minor, 39 per cent deemed it moderate to severe and 18 per cent said they were incapable of evaluating its severity.

Dr Pison said that on the one hand, there was a clear overestimation of the severity in 271 cases (nine per cent) and a tendency towards overestimation in 502 cases (17 per cent). But on the other hand, there was a clear underestimation in 301 cases (10 per cent) and a trend towards underestimation in 1,366 cases (46 per cent) (see figure below).

The score for pain allocated by the triage staff was correlated with the subjective severity score evaluated by the ophthalmologist, (Kendall Tau correlation coefficient T=0,216, p<10-3), said Dr Pison. The majority of patients estimated their pain at about two out of 10 (27 per cent, n= 805 patients).

A total of 43 per cent of patients estimated the severity of their complaint as absent or minor (score zero or one), and 50 per cent of patients had normal behaviour. However, 10 per cent of patients clearly underestimated the severity of their condition and 50 per cent had a tendency towards underestimating their severity, she concluded.


Aurelie Pison:

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