This study aimed to establish the final diagnosis and outcomes for neuro-ophthalmology emergency department (ED) and inpatient consultations for ‘papilledema’. Neuro-ophthalmology consults from ED and inpatient wards for adults referred with ‘papilledema’ were prospectively collected for 12-months in a single centre. The following data was collected: demographics, body mass index (BMI), distance travelled to hospital, presentation information, referral information and representation information. The final diagnosis and outcome were also recorded. A total of 153 neuro-ophthalmology consultations were requested by ED and inpatient wards for ‘papilledema’. These referrals made up 31% of all referrals from ED and inpatient wards to neuro-ophthalmology. Each referral was categorised as: (1) suspected intracranial pressure (ICP) disorder without prior fundus check (24.8%), (2) presumed papilledema from fundus check (58.2%) or (3) known idiopathic intracranial hypertension (IIH) (17.0%). Of the 153, 52% had confirmed papilledema. The study presents several flowcharts of diagnosis and outcome for each of these groups. All of those referred to neuro-ophthalmology having had a prior fundus check were found to have disc oedema/pseudo-papilledema, versus only 35% in the group that didn’t have a prior fundus check. A total of 18% of referrals were diagnosed with a new sight- or life-threatening condition. This study highlights the need for timely assessment of all ‘papilledema’ cases. The authors suggest solutions such as ED access to fundus cameras would allow remote assessment of images to help with limited access to neuro-ophthalmologists and reduce patient travel. These service developments should be evaluated, along with any potential artificial intelligence triage options.
Consultations for ‘papilledema’ for inpatients and in the emergency department
Reviewed by Lauren Hepworth
The increasing burden of emergency department and inpatient consultations for “papilledema”.
CONTRIBUTOR
Lauren R Hepworth
University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.
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