Abstract
Purpose :
To determine whether demographics, examination findings, and quality of care metrics are associated with clinical outcomes in patients with acute CRAO.
Methods :
We performed a retrospective, observational, cohort study of consecutive patients who presented to the Duke University Hospital Emergency Department (DUH ED) with acute CRAO between 01/2013 and 12/2021. Only cases of CRAO confirmed by an ophthalmologist were included. Descriptive statistics were calculated. Linear regression analyses were conducted for continuous outcome variables and logistic for binary categorical outcomes variables.
Results :
A total of 80 confirmed cases of CRAO were included: 45 (56%) were female, 26 (33%) were Black/African American, 1 (1%) was Asian, 50 (63%) were White, and 3 (4%) were multiracial or did not report their race. The majority of patients, 57 (72%) had Medicare coverage while 14 (18%) had private insurance, 6 (8%) had Medicaid, and 3 (4%) were uninsured or had a different form of coverage. Seventy-five (94%) of the cases were non-arteritic. The average distance from the patient’s home to DUH ED was 52 miles (SD=61). The majority of patients 45 (56%) were transferred to our ED after initially presenting elsewhere, and 34 (43%) patients presented initially to DUH ED. The median time to presentation was 9 hours (IQR: 3–21.5). A code stroke was called in 16 (20%) cases. The average logMAR initial and final visual acuity (VA) were 2.3 (SD=0.8) and 2.0 (SD=0.9), respectively. Presenting initially to Duke (p=0.01) and having private insurance (p=0.04) were associated with more improvement in VA. Six (8%) received tPA, and 48 (60%) received hyperbaric oxygen therapy (HBOT). Exam findings associated with worse final VA controlling for initial VA included RAPD (p<0.01), narrowed vessels (p=0.03), retinal whitening (p<0.01), and a history of hypertension (p=0.02). Patients presenting sooner after symptom onset were more likely to have a code stroke called (p<0.01), and having a code stroke called was associated with greater likelihood of getting HBOT (p=0.02) and tPA (p=0.01) as well as quicker time to CT (p=0.04).
Conclusions :
Those presenting initially to Duke instead of as a transfer had better visual outcomes. An emergent, structured workup with neurology and ophthalmology working in tandem is feasible and may be associated with improved visual outcomes.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.