Logo image
Back
Retrospective Optimization of the Hawkeye Orbital Fracture Prioritization and Evaluation Algorithms for Triaging Ophthalmic Care
Journal article   Open access   Peer reviewed

Retrospective Optimization of the Hawkeye Orbital Fracture Prioritization and Evaluation Algorithms for Triaging Ophthalmic Care

Peter H. Sanchez, Erin M. Shriver, Margaret R. Strampe, Ryan J. Diel, Chau M. Pham, Keith D. Carter, Pavlina S. Kemp and Matthew G. Field
Ophthalmology science (Online), Vol.4(3), 100447
05/2024
DOI: 10.1016/j.xops.2023.100447
PMCID: PMC10810741
PMID: 38284103
url
https://doi.org/10.1016/j.xops.2023.100447View
Published (Version of record) Open Access

Abstract

Objectives Many orbital fracture patients are transferred to tertiary care centers for immediate ophthalmology consultation, though few require urgent ophthalmic evaluation or intervention. This overutilizes limited resources and overburdens patients and the healthcare system with travel and emergency department (ED) expenses. A simple, easy to use clinical decision-making tool is needed to aid local EDs and triage services in effectively identifying orbital fracture patients who need urgent ophthalmic evaluation. Design Single center, retrospective cohort study Subjects Orbital fracture patients 18 years and older who presented to the study institution’s emergency department and received an ophthalmology consultation. Methods Ocular injuries that required close monitoring or an intervention within the first few hours after presentation were termed urgent. Two Hawkeye Orbital Fracture Prioritization and Evaluation (HOPE) algorithms were developed to identify orbital fracture patients needing urgent evaluation; including one algorithm incorporating computerized tomography scans interpreted by ophthalmology (HOPE+CT). Algorithms were compared to three previously published protocols: the University of Texas Health Science Center at Houston (UTH), the South Texas Orbital Fracture Protocol (STOP), and Massachusetts Eye and Ear (MEE) algorithms. Main Outcome Measures Correct triage of patients with orbital fractures who have urgent ocular or orbital conditions. Results In the study institution’s ED, 134 adult patients (145 orbits) were seen with orbital fractures in 2019. Eighteen (13.4%) had ocular or orbital conditions categorized as urgent. The HOPE tool resulted in 100% sensitivity and 78.4% specificity. The HOPE+CT tool resulted in 100.0% sensitivity and 94.0% specificity. The UTH algorithm was 91.7% sensitive and 76.5% specific. STOP and MEE were both 100% sensitive but only 35.1% and 32.8% specific, respectively. Conclusions The HOPE and HOPE+CT algorithms were superior or equal to the UTH, STOP, and MEE algorithms in terms of specificity while detecting all urgent cases. Implementation of a triage protocol that uses the HOPE or HOPE+CT algorithms could improve resource utilization and reduce healthcare costs through identification of orbital fracture patients needing urgent evaluation. An online tool that deploys the HOPE+CT algorithm in a user-friendly interface has been developed and is undergoing prospective validation prior to public dissemination.

Details

Metrics

9 Record Views
Logo image