急诊室和住院病人因 "乳头水肿 "就诊的负担越来越重。

IF 2 4区 医学 Q3 CLINICAL NEUROLOGY
Journal of Neuro-Ophthalmology Pub Date : 2024-12-01 Epub Date: 2024-03-19 DOI:10.1097/WNO.0000000000002120
Hetal J Ray, Avital Lily Okrent Smolar, Michael Dattilo, Walid Bouthour, Gabriele Berman, Jason H Peragallo, Sachin Kedar, Andrew M Pendley, James G Greene, Matthew T Keadey, David W Wright, Beau B Bruce, Nancy J Newman, Valérie Biousse
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引用次数: 0

摘要

背景:特发性颅内高压症(IIH)发病率的增加、颅内高压症放射学征兆的过度报道、神经眼科门诊服务的难以获得、保险覆盖率低以及医疗法律方面的担忧降低了因 "乳头水肿 "而到急诊科(ED)就诊的门槛。我们的目的是研究神经眼科急诊室和住院病人因乳头水肿就诊的转诊模式和结果:在一所大学的四级医疗中心,所有在一年内因 "乳头水肿 "转诊的成人都接受了标准化的急诊室 "乳头水肿 "治疗方案。我们收集了患者的人口统计数据、最终诊断和转诊模式:一年来,连续有 153 名患者因乳头水肿转诊。根据乳头水肿方案,153 名患者中有 89 人(58%)出现双侧视盘水肿,其中 89%(79/89)出现乳头水肿(颅内高压)。153 名患者中有 38 名(25%)因怀疑颅内压紊乱而就诊,但之前未进行眼底检查(第 1 组),其中 74%(28/38)没有视盘水肿,21%(8/38)有乳头水肿,5%(2/38)有其他原因导致双侧视盘水肿。在 153 名就诊者中,有 89 人(58%)在眼底检查时发现假性视乳头水肿(第 2 组),其中 58%(66/89)确诊为视乳头水肿,17%(15/89)为假性视乳头水肿,9%(8/89)为其他原因引起的双侧视盘水肿。153 名患者中有 26 人(17%)已知患有 IIH(第 3 组),其中 5 人患有乳头水肿,4 人需要紧急干预。最常见的诊断是 IIH(58/79)。与 IIH 相比,继发性颅内高压患者的年龄更大(P = 0.002)、男性(P < 0.001)、非肥胖(P < 0.001),且更有可能出现神经系统症状(P = 0.002):结论:因 "乳头水肿 "而就诊的住院病人和急诊科病人越来越多。结论:因 "视乳头水肿 "而就诊的急诊室和神经眼科住院病人越来越多。在过去一年中,因 "视乳头水肿 "而就诊的急诊室和神经眼科住院病人共有 153 人,其中三分之一的患者在就诊前曾有过原因不明的视盘水肿,但后来又患上了危及视力或生命的疾病。面对神经眼科专家有限的就诊机会,本研究支持急诊科需要专家眼科评估或眼底照相机来及时识别视盘水肿并对神经急症进行标准化评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Increasing Burden of Emergency Department and Inpatient Consultations for "Papilledema".

Background: Increasing incidence of idiopathic intracranial hypertension (IIH), overreported radiologic signs of intracranial hypertension, difficult access to outpatient neuro-ophthalmology services, poor insurance coverage, and medicolegal concerns have lowered the threshold for emergency department (ED) visits for "papilledema." Our objective was to examine referral patterns and outcomes of neuro-ophthalmology ED and inpatient consultations for concern for papilledema.

Methods: At one university-based quaternary care center, all adults referred for "papilledema" over one year underwent a standardized ED "papilledema protocol." We collected patient demographics, final diagnoses, and referral patterns.

Results: Over 1 year, 153 consecutive patients were referred for concern for papilledema. After papilledema protocol, 89 of 153 patients (58%) had bilateral optic disc edema, among whom 89% (79/89) had papilledema (intracranial hypertension). Of the 38 of 153 (25%) consultations for suspected disorder of intracranial pressure without previous fundus examination (Group 1), 74% (28/38) did not have optic disc edema, 21% (8/38) had papilledema, and 5% (2/38) had other causes of bilateral disc edema. Of the 89 of 153 (58%) consultations for presumed papilledema seen on fundus examination (Group 2), 58% (66/89) had confirmed papilledema, 17% (15/89) had pseudopapilledema, and 9% (8/89) had other causes of bilateral optic disc edema. Of the 26 of 153 (17%) patients with known IIH (Group 3), 5 had papilledema and 4 required urgent intervention. The most common diagnosis was IIH (58/79). Compared with IIH, patients with secondary causes of intracranial hypertension were older ( P = 0.002), men ( P < 0.001), not obese ( P < 0.001), and more likely to have neurologic symptoms ( P = 0.002).

Conclusions: Inpatient and ED consultations for "papilledema" are increasing. Of the 153 ED and inpatient neuro-ophthalmology consultations seen for "papilledema" over 1 year, one-third of patients with optic disc edema of unknown cause before presentation to our ED had new vision- or life-threatening disease, supporting the need for prompt identification and evaluation of optic disc edema in the ED. In the face of limited access to neuro-ophthalmologists, this study supports the need for emergency department access to expert eye-care evaluation or ocular fundus camera for prompt identification of optic disc edema and standardized evaluation for neurologic emergencies.

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来源期刊
Journal of Neuro-Ophthalmology
Journal of Neuro-Ophthalmology 医学-临床神经学
CiteScore
2.80
自引率
13.80%
发文量
593
审稿时长
6-12 weeks
期刊介绍: The Journal of Neuro-Ophthalmology (JNO) is the official journal of the North American Neuro-Ophthalmology Society (NANOS). It is a quarterly, peer-reviewed journal that publishes original and commissioned articles related to neuro-ophthalmology.
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