De Lott LB, et al. - This paper incorporated the elucidation of diplopia presentations in US ambulatory and Emergency Department (ED) settings. The annual occurrence of diplopia visits in the United States was approximately 850,000; 95% were outpatient visits, and diagnoses were rarely serious in the ambulatory setting but potentially life-threatening in 16% of diplopia-related ED visits. As a result of the low probability of a serious neurologic diagnosis in the ambulatory setting and higher probability in an ED, prospective trials were warranted for defining the connection among several diagnostic practice patterns, such as imaging, with patient outcomes.

Methods

• An examination was conducted of the ambulatory and ED visits in the United States by patients with diplopia.
• The trial comprised of a 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 analysis was carried out from October 6, 2016 to August 18, 2017.
• The main outcome included an estimation of the numbers of ambulatory and ED diplopia presentations through weighted sample data.
• This study computed the weighted proportions of patient and clinician (ie, ophthalmologists, general practitioners, and specialty physicians) characteristics, diagnoses, and imaging use.

Results

• 8,04,647 (95% CI, 662,075-947,218) ambulatory and 49,790 (95% CI, 38,318-61,262) diplopia-related ED visits were reported annually.
• It was observed that 12.3% of ambulatory visits were 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.
• Maximum visits 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%]).
• It was discovered that a major proportion of the diplopia-related ambulatory visits were carried out by ophthalmologists (70.4% [95% CI, 62.2%-77.5%]) irrespective of the symptoms being acute or subacute (89.0% [95% CI, 81.0%-93.9%]).
• Diplopia served as the most common diagnosis in both settings (International Classification of Diseases, Ninth Revision, Clinical Modification code 368.2).
• Neither amongst the 10 most frequent diagnoses was life threatening in the ambulatory setting.
• Nevertheless, approximately 16% of diplopia-related ED visits led to stroke or transient ischemic attack diagnosis.
• 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, computed tomography or magnetic resonance imaging was indicated.