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Show Poster 230 "Papilledema" Neuro-Ophthalmology Consultations from the Hospital: A Prospective Study Hetal Ray 1, Avital Lily Okrent 1, Michael Dattilo 2, Walid Bouthour 2, Jason Peragallo 1, Sachin Kedar 1, Nancy Newman 3, Valerie Biousse 4 Emory University School of Medicine, 2 Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA, 3 Departments of Ophthalmology, Neurology, and Neurological Surgery, Emory University School of Medicine, Atlanta, GA, 4 Departments of Ophthalmology and Neurology, Emory University School of Medicine, Atlanta, GA 1 Introduction: Increasing incidence of idiopathic intracranial hypertension (IIH), overreported radiologic signs of IIH (rad-IIH), poor insurance coverage, difficult access to outpatient neuro-ophthalmology and medical-legal concerns have lowered the threshold for urgent emergency department (ED) referral for “papilledema”. We examined referral patterns and outcomes of neuro-ophthalmology consultations (NOC) for papilledema at our institution. Methods: Consecutive neuro-ophthalmology ED and inpatient consultations prospectively collected over 9 months. 106/342 (30.9%) of all patients were referred for “rule-out papilledema” (29/106), “papilledema” (57/106) or known IIH (20/106). Patient demographics, insurance status, referring provider, referral diagnosis, final diagnosis, investigations, and bounce-back rate were collected. Results: Of 29/106 (27.3%) NOC for “rule-out papilledema” (23/29 with headaches; 19/29 with rad-IIH), 5/29 had papilledema. 20/29 did not have papilledema (10 had >1 unnecessary investigations before neuro-ophthalmology consultation). 4/29 had disc edema from vision/life-threatening disorders. Of 57/106 (53.7%) NOC for “papilledema”, 40/57 had true papilledema (36/57 IIH, 3 fulminant; 7/57 vision/life-threatening disease), 10/57 had pseudopapilledema and 7/57 had alternative eye diseases unrelated to intracranial hypertension. 5/10 with pseudopapilledema had unnecessary investigations. Of 20/106 (18.9%) patients with known IIH, 4/20 (20%) had active papilledema. 8/20 had unnecessary repeat neuroimaging. 21/106 had vision/life-threatening disease and 8/21 had prior incomplete evaluations at outside hospitals. Average ED and inpatient hospital stays were 30.5 hours and 13 days, respectively.12/106 returned to the ED within 30 days, despite 9/12 having neuroophthalmology outpatient follow-up. Conclusions: Of 106 NOC, 49 patients had true papilledema (43 IIH), 24/29 patients referred for “rule-out papilledema” did not have papilledema and 17/57 patients referred for “papilledema” did not have papilledema. In the face of limited availability of neuro-ophthalmologists, this study supports the need for onsite presence of an expert eye care provider or tele-ophthalmology for confirmation of papilledema prior to work up in the ED or unnecessary testing will be performed. References: 1. Oh et al; Inpatient and Emergency Room Ophthalmology Consultations at a Tertiary Care Center, J Ophthalmol, 7807391, 2019. 2. Aung et al; Presumptive Idiopathic Intracranial Hypertension Based on Neuroimaging Findings: A Referral Pattern Study, J Neuroophthalmol, Epub ahead of print, 2022. 3. Poostchi et al; Spike in neuroimaging requests following the conviction of the optometrist Honey Rose, Eye (Lond), 32(3):489-90, 2018. Keywords: High intracranial pressure/headache, Pseudotumor cerebri Financial Disclosures: Hetal Ray: No; Avital Lily Okrent: No; Michael Dattilo: No; Walid Bouthour: No; Jason Peragallo: No; Sachin Kedar: No; Nancy Newman: Consultant for GenSight Biologics; research support from GenSight Biologics.; Valerie Biousse: Consultant for GenSight Biologics. Grant Support: None. Contact Information: None provided. 418 | North American Neuro-Ophthalmology Society |
