CLEARED (Chemicals and Litmus testing with Effective Alkaline Range for Eye Damage): A Prospective, Interventional Study

Objectives While immediate diagnosis and irrigation is standard chemical eye burn practice, it is unknown to what extent specific pH measurements influence management, given the frequent clinical availability of narrow‐spectrum nitrazine pH strips. We hypothesize that exclusive broad‐spectrum pH str...

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Bibliographic Details
Published in:Academic emergency medicine 2019-07, Vol.26 (7), p.796-802
Main Authors: Breazzano, Mark P., Day, H. Russell, Tanaka, Sarah, Tran, Uyen, Kuehl, Damon R.
Format: Article
Language:English
Subjects:
Adult
Burns
Burns, Chemical - diagnosis
Chemicals
Emergency medical care
Emergency Service, Hospital
Eye Burns - diagnosis
Eyes & eyesight
Female
Humans
Hydrogen-Ion Concentration
Irrigation
Male
Medical diagnosis
Ophthalmology
Prospective Studies
Time Factors
Triage
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Summary:Objectives While immediate diagnosis and irrigation is standard chemical eye burn practice, it is unknown to what extent specific pH measurements influence management, given the frequent clinical availability of narrow‐spectrum nitrazine pH strips. We hypothesize that exclusive broad‐spectrum pH strip implementation leads to more accurate measurement and expedited ophthalmologic consultation. Methods At a Level I trauma center over 25 months, all emergent adult ophthalmology consultations for chemical burns were included in a pre‐intervention (n = 22) and post‐intervention (n = 20) study design. During this time, narrow‐spectrum nitrazine pH strips available to non‐obstetric emergency department (ED) staff were exclusively replaced by broad‐spectrum strips. Causative chemical, time from triage to ophthalmology consultation, examination findings, ocular pH by ED and ophthalmology staff, and irrigation quantity were analyzed. Results Most burns were alkaline. Time from triage (p = 0.043) and irrigation quantity following consultation (p = 0.047) each decreased following exclusive ED implementation of broad‐spectrum pH strips. There was greater pH congruence between consulting and primary physicians after intervention (p = 0.03). Conclusions Exclusive non‐obstetric implementation of broad‐spectrum pH strips may allow greater accuracy and faster management of ocular chemical burns. Availability of narrow‐spectrum pH strips may be dangerous clinically by falsely reassuring the examiner with inherent inaccuracy.
ISSN:1069-6563
1553-2712
DOI:10.1111/acem.13622