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Emergency Department Presentation of Retinal Artery Occlusion

Published:November 03, 2021DOI:https://doi.org/10.1016/j.oret.2021.10.011

      ABSTRACT

      Purpose

      To determine how often patients who present to the Emergency Department (ED) for retinal artery occlusions (RAOs) undergo brain imaging, cardiovascular testing, and are hospitalized.

      Design

      Retrospective cross-sectional study.

      Participants

      Patients who presented to the ED with a RAO in the National Emergency Department Sample (NEDS), a nationally representative US database.

      Methods

      The NEDS was queried from 2006–2014 to identify patients who presented to the ED with the primary diagnosis of RAO. Patient and hospital characteristics were evaluated, and a multivariable regression was performed to determine predictors of hospitalization. Testing was categorized into three groups: 1) brain imaging – computed tomography and/or magnetic resonance; 2) carotid imaging – ultrasound, computed tomography, and/or magnetic resonance; 3) cardiac testing – electrocardiogram and/or echocardiogram. The number of tests performed for each category was recorded.

      Main Outcome Measures

      Proportions of patients undergoing brain imaging, carotid imaging, and/or cardiac testing. Rate and predictors for hospitalization.

      Results

      Among 259,343,582 ED visits, 2, 802 had a primary diagnosis of RAO. Patients were mostly ≥ 65 years old (59%) and male (54%). Hypertension (59%), dyslipidemia (36%), and diabetes (20%) were the most common pre–existing cardiovascular diseases. Brain imaging, carotid imaging, and cardiac testing were performed in 20.3%, 7.1%, and 23.8% of patients, respectively; at least one test from each of these three categories was performed in 4.1% of patients. Half of the patients were hospitalized. Factors that increased the chances of hospitalization included (P < 0.05): age < 45 years old; female sex; being a smoker; presenting to a metropolitan hospital; having giant cell arteritis, carotid artery disease, atrial fibrillation, cardiac valve disease, obesity, dyslipidemia, hypertension, diabetes, and chronic ischemic heart disease.

      Conclusions

      Most patients who presented to the ED with a RAO did not receive emergent brain imaging, carotid imaging, or basic cardiac testing. A multidisciplinary approach is needed to raise awareness that RAOs should be treated as a precursor of stroke or a stroke equivalent.

      Keywords

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      REFERECNES

      1. Chodnicki KD, Tanke LB, Pulido JS, et al. Stroke Risk before and after Central Retinal Artery Occlusion: A Population-based Analysis [published online ahead of print, 2021 Jul 23]. Ophthalmology. doi:10.1016/j.ophtha.2021.07.017

        • Park S.J.
        • Choi N.K.
        • Yang B.R.
        • et al.
        Risk and Risk Periods for Stroke and Acute Myocardial Infarction in Patients with Central Retinal Artery Occlusion.
        Ophthalmology. 2015; 122 (e2): 2336-2343
        • Mir T.A.
        • Arham A.Z.
        • Fang W.
        • et al.
        Acute Vascular Ischemic Events in Patients With Central Retinal Artery Occlusion in the United States: A Nationwide Study 2003-2014.
        Am J Ophthalmol. 2019; 200: 179-186
        • Chang Y.S.
        • Chu C.C.
        • Weng S.F.
        • Chang C.
        • Wang J.J.
        • Jan R.L.
        The risk of acute coronary syndrome after retinal artery occlusion: a population-based cohort study.
        Br J Ophthalmol. 2015; 99: 227-231
        • Chang Y.S.
        • Jan R.L.
        • Weng S.F.
        • et al.
        Retinal artery occlusion and the 3-year risk of stroke in Taiwan: a nationwide population-based study.
        Am J Ophthalmol. 2012; 154: 645-652
        • Flaxel C.J.
        • Adelman R.A.
        • Bailey S.T.
        • et al.
        Retinal and Ophthalmic Artery Occlusions Preferred Practice Pattern.
        Ophthalmology. 2020; 127: P259-P287
        • Mac Grory B.
        • Schrag M.
        • Biousse V.
        • et al.
        Management of Central Retinal Artery Occlusion: A Scientific Statement From the American Heart Association.
        Stroke. 2021; 52: e282-e294
        • Biousse V.
        • Nahab F.
        • Newman N.J.
        Management of Acute Retinal Ischemia: Follow the Guidelines.
        Ophthalmology. 2018; 125: 1597-1607
      2. Agency for Healthcare Research and Quality. NEDS Database Documentation. https://www.hcup-us.ahrq.gov/db/nation/neds/nedsdbdocumentation.jsp; 2021. Accessed September 22, 2021.

        • Kim J.
        • Byun S.J.
        • Woo S.J.
        • Park K.H.
        • Park S.J.
        Assessment of Trends in the Incidence Rates of Central Retinal Artery Occlusion in Korea From 2002 to 2015.
        JAMA Ophthalmol. 2021; 139: 399-405
        • Callizo J.
        • Feltgen N.
        • Pantenburg S.
        • et al.
        Cardiovascular Risk Factors in Central Retinal Artery Occlusion: Results of a Prospective and Standardized Medical Examination.
        Ophthalmology. 2015; 122: 1881-1888
        • Atkins E.J.
        • Bruce B.B.
        • Newman N.J.
        • Biousse V.
        Translation of clinical studies to clinical practice: survey on the treatment of central retinal artery occlusion.
        Am J Ophthalmol. 2009; 148: 172-173
        • French D.D.
        • Margo C.E.
        • Greenberg P.B.
        Ischemic Stroke Risk in Medicare Beneficiaries with Central Retinal Artery Occlusion: A Retrospective Cohort Study.
        Ophthalmol Ther. 2018; 7: 125-131
        • Lee J.
        • Kim S.W.
        • Lee S.C.
        • Kwon O.W.
        • Kim Y.D.
        • Byeon S.H.
        Co-occurrence of acute retinal artery occlusion and acute ischemic stroke: diffusion-weighted magnetic resonance imaging study.
        Am J Ophthalmol. 2014; 157: 1231-1238
        • Helenius J.
        • Arsava E.M.
        • Goldstein J.N.
        • et al.
        Concurrent acute brain infarcts in patients with monocular visual loss.
        Ann Neurol. 2012; 72: 286-293
        • Lavin P.
        • Patrylo M.
        • Hollar M.
        • Espaillat K.B.
        • Kirshner H.
        • Schrag M.
        Stroke Risk and Risk Factors in Patients With Central Retinal Artery Occlusion.
        Am J Ophthalmol. 2018; 196: 96-100
        • Bergamo C.
        • Juarez-Colunga E.
        • Capp R.
        Association of mental health disorders and Medicaid with ED admissions for ambulatory care-sensitive condition conditions.
        Am J Emerg Med. 2016; 34: 820-824
        • Capp R.
        • Kelley L.
        • Ellis P.
        • et al.
        Reasons for Frequent Emergency Department Use by Medicaid Enrollees: A Qualitative Study.
        Acad Emerg Med. 2016; 23: 476-481
        • Hayreh S.S.
        • Podhajsky P.A.
        • Zimmerman M.B.
        Retinal artery occlusion: associated systemic and ophthalmic abnormalities.
        Ophthalmology. 2009; 116: 1928-1936