Non-mydriatic Ocular Fundus Imaging on Consecutive Headache Patients in an Emergency Department (ED)
Kevin Yan1, George Alencastro1, Andrew Pendley2, Nithya Shanmugam3, Jessica McHenry3, Stuart Duffield3, Daniel Adamkiewicz1, Duyen Vo2, Jordan Prosky3, Matthew Keadey2, David Wright2, Michael Dattilo1, Andrew Fischer1, Mung Yan Lin1, Nancy Newman1, Valerie Biousse1
1Department of Ophthalmology, Emory University, 2Department of Emergency Medicine, Emory University, 3Emory University School of Medicine, Emory University
Objective:
Our goal was to determine how often non-mydriatic ocular fundus photographs with OCT (NMFP-OCT) show relevant fundus findings in a consecutive cohort of patients with headaches in a general ED.
Background:
Papilledema is a red-flag in the evaluation of headache but is often missed in EDs where ocular fundus examination is rarely performed.
Design/Methods:
Quality improvement project, prospective over 16 consecutive days/nights. NMFP-OCT OU [table-top Maestro2/Topcon-Japan] was ordered for all patients presenting to our ED with headaches [as primary (Group1) or secondary complaint (Groups2/3)], or with history of headaches of any kind (Group4). Demographic information, headache classification, final diagnosis and NMFP-OCT findings were collected.
Results:
Of 1838 ED visits over 16 days/nights, 194 patients had headaches and 149 underwent NMFP-OCT in the ED. Group1: 46 patients presented for isolated headache evaluation/treatment; 40 had NMFP-OCT [1 papilledema, 1 dilated retinal vessels from carotid-cavernous fistula, 2 non-relevant findings]; 6 patients without NMFP-OCT in the ED [1 unable to sit, 4 discharged prior, 1 refused]. Group2: 46 patients presented for a neurologic/neurosurgical issue with associated headache; 37 had NMFP-OCT [4 papilledema, 4 relevant retinopathies, 2 optic atrophy, 7 non-relevant findings]; 9 patients without NMFP-OCT in the ED [6 unable to sit, 3 admitted/discharged prior). Group3: 77 patients presented for a non-neurologic issue and had headache; 52 had NMFP-OCT and none had papilledema. Group4: 25 patients with previous history of headache but no active headache (3 with neurologic/neurosurgical issue, 22 with non-neurologic/neurosurgical issue); 20 had NMFP-OCT [no papilledema, 1 optic atrophy].
Conclusions:
NMFP-OCT obtained in the ED in consecutive patients with active headaches allowed for rapid diagnosis of papilledema in 5/86 (5.8%) and other relevant findings in 8/86 (9.3%), with 15 (17.5%) not having NMFP-OCT in the ED. None of the patients with headaches or history of headaches who presented to the ED for other reasons had papilledema.
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