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Multicenter Study
. 2011 Feb;25(2):161-7.
doi: 10.1038/eye.2010.173. Epub 2010 Dec 3.

Accuracy of referrals for visual assessment in a stroke population

F J Rowe  1 ; VIS Group
Collaborators, Affiliations
Multicenter Study

Accuracy of referrals for visual assessment in a stroke population

F J Rowe et al. Eye (Lond). 2011 Feb.

Abstract

Purpose: To evaluate accuracy of referrals from multidisciplinary stroke teams requesting visual assessments.

Patients and methods: Multicentre prospective study undertaken in 20 acute Trust hospitals. Stroke survivors referred with suspected visual difficulty were recruited. Standardised screening/referral and investigation forms were used to document data on referral signs and symptoms, plus type and extent of visual impairment.

Results: Referrals for 799 patients were reviewed: 60% men, 40% women. Mean age at onset of stroke was 69 years (SD 14: range 1-94 years). Signs recorded by referring staff were nil in 58% and positive in the remainder. Symptoms were recorded in 87%. Diagnosis of visual impairment was nil in 8% and positive in the remainder. Sensitivity of referrals (on the basis of signs detected) was calculated as 0.42 with specificity of 0.52. Kappa statistical evaluation of agreement between referral and diagnosis of visual impairment was 0.428 (SE 0.017: 95% confidence interval of -0.048, 0.019).

Conclusion: More than half of patient referrals were made despite no signs of visual difficulty being recorded by the referring staff. Visual impairment of varying severity was diagnosed in 92% of stroke survivors referred for visual assessment. Referrals were made based predominantly on visual symptoms and because of formal orthoptic liaison in Trusts involved.

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Figures

Figure 1
Figure 1
Standardised screening form used by all participating recruitment centres. This doubled as the referral form when completed.
Figure 2
Figure 2
The x axis depicts the visual signs recorded by referring staff. The y axis depicts the numbers of patients. A total of 460 patients (58%) had no visual signs recorded by the referring staff.
Figure 3
Figure 3
The x axis depicts the visual symptoms recorded by referring staff. The y axis depicts the number of patients. A total of 107 patients (13%) had no visual symptoms recorded by the referring staff.
Figure 4
Figure 4
The x axis depicts the visual diagnosis made at eye examination. The y axis depicts the number of patients. A total of 63 patients (8%) had no visual anomalies detected when examined by the eye care team.
See this image and copyright information in PMC

References

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