To highlight the need for a papilledema triage protocol in major medical centers. 

Many patients present to Emergency Departments (ED) with neuro-ophthalmologic complaints, particularly “disc edema” determined by optometrists/ophthalmologists, whether symptomatic or not. Disc edema includes papilledema, infection, and other causes. These presentations burden ED, ophthalmology, and neurology teams, and may lead to costly admissions for outpatient workup.  

Thirty neurology residents (PGY2-PGY4 trainees) were emailed a five-question survey. Questions surveyed confidence levels assessing papilledema without ophthalmology input, confidence determining if patients should be admitted without ophthalmology input (and conversely with ophthalmology input), views on whether a papilledema triage protocol is needed, and how a triage protocol impacts neurology services.

Eight PGY2, seven PGY3, and seven PGY4 residents completed the survey. For questions regarding confidence in papilledema assessments and admission decisions, trainees responded from 1 (not confident at all) to 10 (very confident). Average scores for confidence were 2.6 when assessing papilledema alone, 2.3 for deciding admission without ophthalmology, and 7.5 for deciding admission with ophthalmology input. 86% of respondents agreed/strongly agreed a triage system should exist, and 82% agreed/strongly agreed a triage system would positively impact neurology services. 

Survey results highlight the need for a papilledema triage protocol to improve diagnosis, resource allocation, and neurology team burden. Additionally, a protocol would likely improve ED and ophthalmology efficiency and workload.  

Our proposal pending implementation triages patients based on symptoms. All patients with disc edema findings with or without symptoms receive CTH and a visual acuity exam by the ED. If reassuring, asymptomatic patients obtain next day ophthalmology outpatient exams. Mild-moderate symptomatic patients also receive CTV, neurology consult, and ophthalmology consult if visual acuity is below a threshold, with admission decision pending workup. Moderate-severe symptomatic patients have neurology and ophthalmology consult with plan for admission and full workup.