National Trends in Imaging Rates for Eye-Related Emergency Department Visits in the United States

PURPOSE: To identify nationwide trends and factors associated with advanced imaging (computed tomography [CT] and magnetic resonance imaging [MRI]) use for eye-related emergency department (ED) visits. DESIGN: Retrospective, trend study. METHODS: SETTING: National Hospital Ambulatory Medical Care Survey 2007-2015. PATIENT POPULATION: Eye-related ED patients who underwent CT or MRI. MAIN OUTCOME MEASURE(S): Population-based CT/MR imaging rates and independent factors associated with imaging. RESULTS: An estimated 7 million eye-related ED visits occurred between 2007 and 2015. Adjusted for annual eye-related ED visits, the rate of imaging use rose 94%, from 121.7 per 1,000 eye-related ED visits in 2007 to 236.0 per 1,000 eye-related ED visits in 2015. Visual disturbances, contusion of the eye and/or adnexa, open globes and open wounds of ocular adnexa, diplopia, superficial corneal and/or conjunctival injuries, and orbital fractures accounted for 73.2% of all visits where imaging was performed. On multivariable analysis, older patients (odds ratio [OR] = 1.02, 95% confidence interval [CI] 1.01-1.03) and females (OR = 2.07, 95% CI 1.18-3.63) were more likely to undergo imaging than younger patients and males. Imaging was also more likely to be performed for Medicare beneficiaries (OR = 2.12, 95% CI 1.08-4.15) than for privately insured patients. Patients who were admitted to the hospital were 6 times more likely (OR = 6.39, 95% CI 2.04-20.0) to undergo imaging than those who were not admitted. CONCLUSIONS: Advanced imaging for eye-related ED visits has escalated at a higher rate than ED visits for eye complaints. Future studies to develop evidencebased algorithms for use of CT/MR imaging for eye complaints that can help balance benefits against financial costs and health risk are warranted. ((C) 2019 Elsevier Inc. All rights reserved.)