Demographic patterns of ED patients diagnosed as having corneal ulcer

This work aimed to study the demographic features of patients with emergency department (ED) visits for ulcerative keratitis, including information on insurance coverage and on-site consultant support.

Demographic features of corneal ulcers diagnosed in the ED were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes in Florida Agency of Health Care data sets for 2010. Patterns of patient encounters, including type of insurance coverage and consultant ED visits, were analyzed foremost descriptively.

In 2010, 2124 patients were evaluated in EDs in Florida with the primary diagnosis of corneal ulcer. Of these patients, 190 required hospital admission for further care. Thirty percent of patients discharged from the ED were seen on the weekend. About one-third of patients had no insurance (34.7%). Compared with outpatients, those hospitalized were older (54 years vs 39 years [P < .001]) and more often had insurance coverage (90.5% vs 65.3% [P < .001]). Ophthalmologists were associated with as many as 70.9% of outpatient encounters. The ratio of outpatients to those requiring hospitalization in urban areas ranged from 2.3 to 1 in counties on the west coast of Florida to 28.1 to 1 among counties in the southeast coast.

Emergency department participation by ophthalmologist for ulcerative keratitis was relatively high. Whether the lack of health insurance affects the decision to hospitalize patients with corneal ulcers is a question that deserves further study. What influence the high proportion of uninsured ED patients will have on ophthalmologists coverage in the future may need to be addressed.