National Trends in Central Retinal Artery Occlusion Presentations and Stroke Workup in United States Emergency Department.

Abstract

Purpose: To investigate trends in acute central retinal artery occlusion (CRAO) diagnostic assessments and sociodemographic characteristics of patients in the United States (US) emergency department (ED).

Design: Retrospective trend study.

Subjects: Adult patients with CRAO presenting to ED from 2016 through 2021.

Methods: The National Emergency Department Sample (NEDS) was queried with International Classification of Diseases, Tenth Revision (ICD-10) codes with a primary diagnosis of CRAO. Stroke workup modalities assessed included brain imaging (CT/CTA and MRI/MRA), carotid imaging (US, CTA, MRA), cardiac diagnostics (Echocardiogram/ECG), and laboratory workup (ESR/CRP).

Main outcome measure: Proportion of studied participants receiving stroke workup modalities.

Results: 3,736 patients were identified with mean age of 69 [13.72] years, majority were male (53.02%), and predominantly insured by Medicare (62.77%). Comorbidities included hypertension (75.45%), hyperlipidemia (44.67%), coronary artery disease (20.26%), diabetes (27.38%), and obesity (11%). CRAO incidence significantly increased over the five-year period from 1,698 to 3,526 (p=0.024). Utilization rates of all workup modalities including brain imaging, carotid imaging, heart, and laboratory tests showed a linear increase from 2016 through 2021. The proportion of patients receiving no stroke workup decreased from 66.75% to 57.87% (p=0.259).

Conclusions: The US has increased the screening and stroke workup of CRAO in the ED over time, yet greater than 50% of patients continue to not receive any type of stroke workup imaging. Greater awareness of these trends and current guidelines could result in improved screening and patient outcomes.