Diagnostic errors in ophthalmic presentations to emergency departments in Melbourne.

Abstract

Purpose: To determine the nature and rates of diagnostic errors amongst ophthalmic presentations to emergency departments (ED) in Melbourne. Method(s): Multi-site, retrospective audit of 100 consecutive ophthalmic presentations at each of five general EDs and one specialty eye ED in Melbourne from the week commencing 6 May 2019. Result(s): Six hundred presentations were analysed. The most common presenting symptoms were pain (42%) and/or red eyes (28%) and decreased vision (20%). The most common diagnoses were corneal abrasion (12.6%), corneal or subtarsal foreign body (12%) and conjunctivitis (11.7%). There were 35 (5.8%) neuro-ophthalmic, 29 (4.8%) corneal and 29 (4.8%) vitreo-retinal presentations, and 26 (4.3%) chemical injuries. Excluding patients seen in the specialty ED, 132 patients (26%) had an ophthalmology review (including phone advice) at the time of initial presentation. A further 50 patients (10%) were referred for outpatient review. There were two presentations where an incorrect diagnosis was made. The first was at a general ED where conjunctivitis was diagnosed. HSV keratitis was observed at subsequent follow-up. The second presented to the specialty ED with a possible missed diagnosis, when a posterior vitreous detachment was diagnosed. A review one week later revealed a retinal detachment. Forty-one (6.8%) patients had an unplanned re-presentation. No patient had a change in the diagnosis at the second presentation. Conclusion(s): Based on this audit, patients present to EDs with ophthalmic conditions with a low risk of a misdiagnosis. For more serious presentations, hospitals are well supported by ophthalmology units in ensuring patients are diagnosed appropriately.