Clinical indicators and usage of algorithms in determining need for ophthalmological consultation in the setting of orbital fractures

Purpose Orbital fractures are a major reason for ophthalmologic consultation in the emergency department. In this study, we studied ocular signs associated with intervention and compared 4 previously published protocols to identify which best identified higher risk patients in need of consultation.Methods We performed a retrospective cross-sectional study of patients from the BALCITE (BALtimore Consultation, Inpatient, and Trauma of the Eye) database who received ophthalmologic consultation. Our primary outcomes were the ocular and orbital signs associated with receiving intervention. Our secondary outcome identified the most sensitive and specific screening algorithm for orbital fractures by comparing four existing protocols (HOPE+CT, STOP, MEE, and UTH) to our large independent cohort.Results Of 814 patients with 913 eyes, 218 (24%) eyes required intervention. rAPD and periorbital laceration had the highest odds of intervention (aOR 5.7 [CI 3.2–10.1], p < 0.001 and aOR 3.3 [CI 2.3–4.7], p < 0.001, respectively). A 1-point increase in logMAR visual acuity corresponded to a 2.9-fold increase in the odds of intervention (p < 0.001). The STOP tool had the highest sensitivity of 96.3%, demonstrating a potential 29% reduction in hospital fracture consults, followed by MEE, with a sensitivity of 93.1%. The HOPE+CT tool had the highest specificity of 95.6%.Conclusion The presence of an APD and periorbital laceration are strong indicators of urgent ophthalmologic treatment in the setting of acute orbital fractures. Supportive implementation of the STOP and MEE algorithms can effectively screen orbital fracture patients to help triage in the acute setting, improve resource utilization, and reduce healthcare costs.