Develop a simple phone questionnaire, without physical exam input, that predicts which patients calling with symptoms of a posterior vitreous detachment (PVD) have a retinal tear or rhegmatogenous retinal detachment (RT/RD).
Prospective cohort (quality improvement) study.
All patients with symptoms consistent with a PVD calling a major academic ophthalmology department over a four-month period in 2020 and were seen on follow-up within 1.5 months (211 screened, 193 included).
A comprehensive phone questionnaire assessing for RT/RD risk factors was administered by phone triage staff to all patients calling with symptoms of flashes, floaters, or curtain/veil in their vision. Multivariable logistic regression was used to determine risk factors most predictive of having a RT/RD during the add-on visit. Risk factor odds ratios were used to develop a RT/RD risk score.
Development of a clinical risk score for having a RT/RD at the add-on visit following phone triage.
Approximately 55% of patients were previously established in the retina clinic, 26% were new to the department, 19% were previously established in the comprehensive clinic, and 7% had a RT/RD at the add-on visit. Out of 23 questions and 70 pre-specified possible answers from the phone questionnaire, the final clinical risk score for RT/RDs is derived from 7 questions and 15 possible answers. The simplified questionnaire can be administered quickly by phone operators without any reference to physical exam or the patient’s chart. The receive-operator curve for our final multivariable logistic regression and clinical risk score models have an area under the curve of >0.90. Using a conservative clinical risk score, nearly 50% of all patients without a RT/RD can be safely seen non-urgently. Progressively higher scores can be used to determine relative urgency of an appointment.
This is the first study to predict risk of a RT/RD in a patient calling with symptoms consistent with a PVD without reference to the patient’s physical exam or chart. Our clinical risk scoring system can be used to determine urgency of an add-on appointment and increase the number of low-risk patients with symptomatic PVDs that are scheduled routinely.

Copyright © 2023. Published by Elsevier Inc.