<p class="first" id="d9651086e288">This secondary analysis of cross-sectional, population-based
survey data collected
in the United States from 2003 through 2012 assesses the frequency, diagnostic practices,
and patient and physician characteristics in diplopia presentations to emergency department
and ambulatory settings.
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<h5 class="section-title" id="d9651086e294">Question</h5>
<p id="d9651086e296">How common are diplopia-related visits to ambulatory and emergency
department settings
in the United States?
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<h5 class="section-title" id="d9651086e299">Findings</h5>
<p id="d9651086e301">In this prespecified secondary analysis of cross-sectional, population-based
survey
data collected from 2003 through 2012, there were 804 647 ambulatory and 49 790 emergency
department visits annually for diplopia. Most ambulatory visits occurred with ophthalmologists
(70.4%), and diplopia was frequently the primary reason for ambulatory setting (48.6%)
or emergency department (36.5%) visits.
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<h5 class="section-title" id="d9651086e304">Meaning</h5>
<p id="d9651086e306">Diplopia-related visits are common in the United States, suggesting
that future studies
defining patient outcomes and association of practice patterns with outcomes should
be largely aimed at practices providing eye care.
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<h5 class="section-title" id="d9651086e310">Importance</h5>
<p id="d9651086e312">Diplopia is believed to be a common eye-related symptom. However,
to date, there are
no available population-based estimates, which are necessary to understand the impact
of this disabling symptom on the health care system and to identify steps to optimize
patient care.
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<h5 class="section-title" id="d9651086e315">Objective</h5>
<p id="d9651086e317">To describe diplopia presentations in US ambulatory and emergency
department (ED)
settings.
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<h5 class="section-title" id="d9651086e320">Design, Setting, and Participants</h5>
<p id="d9651086e322">Ambulatory and ED visits in the United States by patients with
diplopia were analyzed
in this prespecified secondary analysis of National Ambulatory Medical Care Survey
and National Hospital Ambulatory Medical Care Survey data collected for a 10-year
period (2003-2012). Data were analyzed for the present study from October 6, 2016
to August 18, 2017.
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<h5 class="section-title" id="d9651086e325">Main Outcomes and Measures</h5>
<p id="d9651086e327">Numbers of ambulatory and ED diplopia presentations were estimated
using weighted
sample data. Weighted proportions of patient and clinician (ie, ophthalmologists,
general practitioners, and specialty physicians) characteristics, diagnoses, and imaging
use were calculated.
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<h5 class="section-title" id="d9651086e330">Results</h5>
<p id="d9651086e332">In total, 804 647 (95% CI, 662 075-947 218) ambulatory and 49 790
(95% CI, 38 318-61 262)
diplopia-related ED visits occurred annually; 12.3% of ambulatory visits were primarily
for acute- or subacute-onset diplopia. Mean (SD) patient age was 62.1 (20.3) years
for ambulatory vs 48.1 (22.3) years for diplopia-related ED visits. Most visits primarily
for diplopia were by patients 50 years or older (ambulatory, 79.1% [95% CI, 72.9%-84.2%];
ED, 51.8% [95% CI, 41.0%-62.4%]) who were white (ambulatory, 81.7% [95% CI, 74.8%-87.0%];
ED, 86.1% [95% CI, 77.8%-91.6%]) women (ambulatory, 51.1% [95% CI, 44.1-58.1]; ED,
52.8% [95% CI, 41.6%-63.7%]). Most diplopia-related ambulatory visits were conducted
by ophthalmologists (70.4% [95% CI, 62.2%-77.5%]) even when symptoms were acute or
subacute (89.0% [95% CI, 81.0%-93.9%]). The most common diagnosis in both settings
was diplopia (
<i>International Classification of Diseases, Ninth Revision, Clinical Modification</i>
code 368.2). None of the 10 most frequent diagnoses was life threatening in the ambulatory
setting, but approximately 16% of diplopia-related ED visits resulted in a stroke
or transient ischemic attack diagnosis. Computed tomography or magnetic resonance
imaging was ordered in 6.2% (95% CI, 2.8%-12.9%) of ambulatory and 59.7% (95% CI,
38.6%-77.7%) of ED visits, primarily for diplopia.
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<h5 class="section-title" id="d9651086e338">Conclusions and Relevance</h5>
<p id="d9651086e340">Approximately 850 000 diplopia visits occur in the United States
annually; 95% were
outpatient visits, and diagnoses were rarely serious in the ambulatory setting but
potentially life threatening in 16% of diplopia-related ED visits. Given the low probability
of a serious neurologic diagnosis in the ambulatory setting and higher probability
in an ED, future cohort studies are needed to define the association of various diagnostic
practice patterns, such as imaging, with patient outcomes.
</p>
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