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Nationwide trends in emergency department utilisation for acute retinal ischaemia in the USA, 2011–2018
  1. Ali G Hamedani1,2,3,4,
  2. Lindsey B De Lott5,
  3. Allison W Willis1,3,4,6
  1. 1 Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2 Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
  3. 3 Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania, Philadelphia, PA, USA
  4. 4 Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA
  5. 5 University of Michigan, Ann Arbor, Michigan, USA
  6. 6 Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
  1. Correspondence to Dr Ali G Hamedani, Departments of Neurology and Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; ali.hamedani{at}pennmedicine.upenn.edu

Abstract

Background Guidelines recommend urgent evaluation for transient monocular vision loss (TMVL) and retinal artery occlusion (RAO), but emergency department (ED) utilisation for these conditions is unknown.

Methods We performed a retrospective longitudinal cross-sectional analysis of the Nationwide Emergency Department Sample (2011–2018), a database of all ED visits from a representative 20% sample of US hospital-based EDs. We identified patients aged 40 and older with a primary diagnosis of TMVL or RAO and calculated the weighted number of total visits and admission rate by year. We used joinpoint regression to analyse time trends and logistic regression to measure differences according to demographic characteristics and comorbidities.

Results There were an estimated 2451 ED visits for TMVL and 2472 for RAO annually in the USA from 2011 to 2018. Approximately 36% of TMVL and 51% of RAO patients were admitted. The admission rate decreased by an average of 4.9% per year for TMVL (95% CI −7.5% to −2.3%) and 2.2% per year for RAO (95% CI −4.1% to −0.4%), but the total number of ED visits did not change significantly over time. Elixhauser Comorbidity Index and hyperlipidaemia were associated with increased odds of hospital admission for both TMVL and RAO. There were also differences in admission rate by insurance payer and hospital region.

Conclusion Of the estimated 48 000 patients with TMVL or RAO annually in the USA, few are evaluated in the ED, and admission rates are less than for transient ischaemic attack or ischaemic stroke and are decreasing over time.

  • Epidemiology
  • Public health

Data availability statement

Data may be obtained from a third party and are not publicly available. NEDS is publicly available for purchase through HCUP to qualified users.

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Data availability statement

Data may be obtained from a third party and are not publicly available. NEDS is publicly available for purchase through HCUP to qualified users.

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Footnotes

  • Contributors AGH conceived of the study, designed and performed the statistical analysis, and primarily drafted the manuscript. LDL and AWW critically reviewed the manuscript. AGH had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. AGH is the guarantor.

  • Funding This work was supported by the Translational Centre of Excellence for Neuroepidemiology and Neurology Outcomes Research at the University of Pennsylvania (grant number: N/A).

  • Disclaimer The sponsor or funding organisation had no role in the design or conduct of this research.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.