Evaluation of the Manchester Triage System in Patients with Acute Primary Angle Closure Attack: A Retrospective Study

Authors

  • Margarida Ribeiro Co-first author. Ophthalmology. Centro Hospitalar e Universitário de São João. Porto; Biomedicine Department. Unit of Farmacology and Therapeutics. Faculdade de Medicina. Universidade do Porto. Porto. Portugal. https://orcid.org/0000-0002-0196-3840
  • João Barbosa-Breda Co-first author. Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; UnIC@RISE. Departmento of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal; KU Leuven. Research Group Ophthalmology. Department of Neurosciences. Leuven. Belgium https://orcid.org/0000-0001-7816-816X
  • Francisco Gonçalves Faculdade de Medicina. Universidade do Porto. Porto. Portugal.
  • Ana Faria Pereira Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto. Portugal.
  • Fernando Falcão-Reis Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; Department of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal
  • Flávio Alves Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto. Portugal.
  • Sérgio E. Silva Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; Department of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal. https://orcid.org/0000-0002-7415-813X
  • António B. Melo Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; Department of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal.

DOI:

https://doi.org/10.20344/amp.19170

Keywords:

Emergency Service, Hospital, Glaucoma, Angle-Closure/diagnosis, Glaucoma, Angle-Closure/therapy, Triage

Abstract

Introduction: Acute primary angle closure attack is an ophthalmological emergency. The aim of this study was to describe the cases diagnosed in the Emergency Department, by correlating the initial complaint with the Manchester triage level and ultimately the time needed until ophthalmological evaluation and iridotomy.

Material and Methods: Retrospective analysis of the electronic medical records of patients with acute primary angle closure attack that attended the Ophthalmology Emergency Department of our tertiary center between January 2010 and December 2020. Overall, 2228 Emergency Department episodes coded with the diagnoses glaucoma or ocular hypertension were retrieved, followed by screening of each episode for correct identification of true acute primary angle closure attacks. Clinical data was gathered, including Manchester triage level, presenting complaint, intraocular pressure at presentation, first medical specialty that observed the patient, time until observation by Ophthalmology and time until laser iridotomy.
Results: Among the 120 patients identified, 84 (70%) were female and the mean age was 68 ± 12 years. Mean intraocular pressure at admission was 53.4 ± 12.4 mmHg, and 9.2% of patients presented only non-ocular complaints, while 9.2% presented mixed complaints (ocular and non-ocular). Most patients (68.1%) with only non-ocular or mixed complaints were triaged to a non-ophthalmologist (p < 0.001). Concerning the triage system, at admission, most patients (66.7%) were labelled yellow (urgent), while 9.2% and none were labelled as orange (very urgent) or red (emergent), respectively. Most patients (83.3%) were directly sent to Ophthalmology (properly triaged), while the remaining were incorrectly assigned to a non-ophthalmologist. Median time until observation by Ophthalmology was 49 minutes in the properly triaged group (min. 15, max. 404), while it was 288 minutes (min. 45, max. 871) in those who were incorrectly triaged (p < 0.001). Likewise, median time until treatment with laser iridotomy was 203 minutes in the properly triaged group (min. 22, max. 1440) and 353 minutes in the incorrectly triaged group (min.112, max. 947) (p < 0.001).
Conclusion: Most patients with acute primary angle closure attack were not properly triaged according to the level of the Manchester triage system. There was a significant delay in the diagnosis and treatment of those patients who were first assigned to non-ophthalmologists. There is a need to raise awareness regarding the presenting signs and symptoms of an acute primary angle closure attack in order to avoid preventable vision loss.

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References

Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121:2081-90.

Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90:262-7.

European Glaucoma Society. Terminology and guidelines for glaucoma, 5th edition. Br J Ophthalmol. 2021;105:S1-169.

European Glaucoma Society. European Glaucoma Society terminology and guidelines for glaucoma, 4th edition - chapter 3: treatment principles and options supported by the EGS Foundation: part 1: foreword; introduction; glossary; chapter 3 treatment principles and options. Br J Ophthalmol. 2017;101:130-95.

Tarongoy P, Ho CL, Walton DS. Angle-closure glaucoma: the role of the lens in the pathogenesis, prevention, and treatment. Surv Ophthalmol. 2009;54:211-25.

Alper MG, Laubach JL. Primary angle-closure glaucoma in the American Negro. Arch Ophthalmol. 1968;79:663-8.

Alsbirk PH. Angle-closure glaucoma surveys in Greenland Eskimos. A preliminary report. Can J Ophthalmol. 1973;8:260-4.

Drance SM. Angle closure glaucoma among Canadian Eskimos. Can J Ophthalmol. 1973;8:252-4.

Shah SM, Khanna CL. Ophthalmic emergencies for the clinician. Mayo Clin Proc. 2020;95:1050-8.

Ozaki M. Major determinants of acute primary angle closure demonstrated by anterior segment optical coherence tomography. Invest Ophthalmol Vis Sci. 2013;54:5287.

Lachkar Y, Bouassida W. Drug-induced acute angle closure glaucoma. Curr Opin Ophthalmol. 2007;18:129-33.

Yang MC, Lin KY. Drug-induced acute angle-closure glaucoma: a review. J Curr Glaucoma Pract. 2019;13:104-9.

Uhr JH, Mishra K, Wei C, Wu AY. Awareness and knowledge of emergent ophthalmic disease among patients in an internal medicine clinic. JAMA Ophthalmol. 2016;134:424-31.

Razmjoo H, Rezaei L, Dehghani A, Peyman A, Akhlaghi M. Bilateral angle-closure glaucoma in a young female receiving cabergoline: a case report. Case Rep Ophthalmol. 2011;2:30-3.

Razeghinejad MR, Pro MJ, Katz LJ. Non-steroidal drug-induced glaucoma. Eye. 2011;25:971-80.

Pedrosa AC, Rodrigues Araújo J, Macedo JP, Estrela Silva S, Melo A, Falcão-Reis Fernando. Bilateral angle narrowing and acute myopia induced by indapamide: a case report. Case Rep Ophthalmol Med. 2018;2018:1486128.

Singer JR, Pearce ZD, Westhouse SJ, Siebert KJ. Uveal effusion as a mechanism of bilateral angle-closure glaucoma induced by chlorthalidone. J Glaucoma. 2015;24:84-6.

Ritch R, Chang BM, Liebmann JM. Angle closure in younger patients. Ophthalmology. 2003;110:1880-9.

Direçã o-Geral da Saúde. Norma n.º 002/2018 de 09/01/2018. Sistemas de Triagem dos Serviços de Urgência e Referenciação Interna Imediata. Lisboa: DGS; 2018.

Grupo Português de Triagem. O sistema de triagem de Manchester e as vias verdes. Amadora: Hospital Amadora Sintra; 2011.

Malone DA, Camara EG Jr, Krug JH Jr. Ophthalmologic effects of psychotropic medications. Psychosomatics. 1992;33:271-7.

Kadoi C, Hayasake S, Tsukamoto E, Mtumoto M, Hayasaka Y, Nagaki Y. Bilateral angle closure glaucoma and visual loss precipitated by antidepressant and antianxiety agents in a patient with depression. Ophthalmologica. 2000;214:360-1.

Hatta M, Hayasaka S, Kato T, Kadoi C. Retrobulbar optic neuritis and rhegmatogenous retinal detachment in a fourteen-year-old girl with retinitis pigmentosa sine pigmento. Ophthalmologica. 2000;214:153-5.

Fritze J, Schneider B, Weber B. Benzodiazepine und benzodiazepin-ähnliche anxiolytika und hypnotika die unplausible kontraindikation engwinkelglaukom. Nervenarzt. 2002;73:50-3.

Direcção de Serviços de Cuidados de Saúde/Comissão de Coordenação do Programa Nacional para a Saúde da Visão. Boas práticas na oftalmologia – elementos clínicos de avaliação e referenciação. Lisboa: Direçã o-Geral da Saúde; 2008.

Published

2023-03-17

How to Cite

1.
Ribeiro M, Barbosa-Breda J, Gonçalves F, Faria Pereira A, Falcão-Reis F, Alves F, E. Silva S, B. Melo A. Evaluation of the Manchester Triage System in Patients with Acute Primary Angle Closure Attack: A Retrospective Study. Acta Med Port [Internet]. 2023 Mar. 17 [cited 2024 Mar. 5];36(11):698-705. Available from: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/19170

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