Abstract
Purpose :
Papilledema consultation is common for ophthalmologists in the hospital setting; however, the utility of screening has not been thoroughly evaluated. The purpose of this study is to determine the proportion of papilledema consults that resulted in confirmatory findings and whether the consultations impacted management.
Methods :
A retrospective chart review was performed of consecutive hospital and emergency room patients evaluated by the ophthalmology service at a single academic center between January 1, 2015 – January 1, 2019. Eligible patients had a diagnosis code of papilledema, optic nerve swelling, headache, idiopathic intracranial hypertension (IIH), venous sinus thrombosis (VST), hydrocephalus, or Ventriculoperitoneal (VP) shunt failure. Data collection included age, gender, requesting service, primary diagnosis, relevant medications, headache, visual symptoms, obesity or recent weight gain, pre-existing diagnosis of papilledema/IIH/VST/VP shunt, visual acuity, presence of optic nerve swelling on examination, radiographic findings of elevated ICP, and change in patient management as a result of the ophthalmology findings.
Results :
A total of 394 papilledema consults were identified, 239 Female and 155 Male, with a mean age of 30, range (newborn-87). A total of 9 different services consulted Ophthalmology with Emergency Medicine (49%), Neurology (20%), and Internal Medicine (9%) being the most frequent. Common reasons for the consult were papilledema check (57%) and vision changes (17%). There were 65 patients (16.5%) with a pre-existing diagnosis of papilledema. A positive diagnosis of papilledema occurred in 237 of the total consults (60%). A change in management occurred in 211 of the total consults (53.55%).
Conclusions :
Approximately 60% of consults resulted in a papilledema diagnosis, and half of these led to a change in management. These data suggest ongoing utility to papilledema consultations. Further studies can be conducted to determine factors with higher sensitivity and specificity to reduce the number of low-yield papilledema consults.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.