Department of Ophthalmology, Howard University College of Medicine, Washington, DC.
Department of Ophthalmology, Howard University College of Medicine, Washington, DC.
Ophthalmol Retina. 2022 Apr;6(4):318-324. doi: 10.1016/j.oret.2021.10.011. Epub 2021 Nov 3.
To determine how frequently patients who present to an emergency department (ED) with a retinal artery occlusion (RAO) undergo brain imaging and cardiovascular testing and are hospitalized.
Retrospective cross-sectional study.
Patients who presented to an ED with an RAO in the National Emergency Department Sample (NEDS), a nationally representative United States database.
The NEDS was queried to identify patients who presented to an ED with the primary diagnosis of RAO between 2006 and 2014. Patient and hospital characteristics were evaluated, and a multivariable regression was performed to determine predictors of hospitalization. Testing was categorized into 3 groups: (1) brain imaging performed using computed tomography or magnetic resonance; (2) carotid imaging performed using ultrasound, computed tomography, or magnetic resonance; and (3) cardiac testing performed using electrocardiogram or echocardiogram. The number of tests performed for each category was recorded.
Proportions of patients undergoing brain imaging, carotid imaging, or cardiac testing. Rate and predictors of hospitalization.
Among 259 343 582 ED visits, 2802 had a primary diagnosis of RAO. Patients were mostly aged ≥65 years (59%) and male (54%). Hypertension (59%), dyslipidemia (36%), and diabetes (20%) were the most common preexisting cardiovascular diseases. Brain imaging, carotid imaging, and cardiac testing were performed in 20.3%, 7.1%, and 23.8% of the patients, respectively; at least 1 test from each of these 3 categories was performed in 4.1% of the patients. Half of the patients were hospitalized. Factors that increased the chances of hospitalization included the following (P < 0.05): age of <45 years; female sex; a history of smoking; presenting to a metropolitan hospital and having giant cell arteritis, carotid artery disease, atrial fibrillation, cardiac valve disease, obesity, dyslipidemia, hypertension, diabetes, and chronic ischemic heart disease.
Most patients who presented to an ED with an RAO did not receive emergency 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.
确定因视网膜动脉阻塞（RAO）到急诊科（ED）就诊的患者接受脑部成像和心血管检查以及住院治疗的频率。
回顾性横断面研究。
参与国家急诊数据库（NEDS）的 ED 中以 RAO 为主要诊断的患者。
对 NEDS 进行查询，以确定在 2006 年至 2014 年间以 ED 中 RAO 为主要诊断的患者。评估患者和医院特征，并进行多变量回归以确定住院治疗的预测因素。检查分为 3 组：（1）使用计算机断层扫描或磁共振进行脑部成像；（2）使用超声、计算机断层扫描或磁共振进行颈动脉成像；（3）使用心电图或超声心动图进行心脏检查。记录每个类别进行的检查次数。
接受脑部成像、颈动脉成像或心脏检查的患者比例。住院率和住院治疗的预测因素。
在 259343582 次 ED 就诊中，有 2802 次就诊的主要诊断为 RAO。患者主要年龄≥65 岁（59%）和男性（54%）。最常见的既往心血管疾病是高血压（59%）、血脂异常（36%）和糖尿病（20%）。脑部成像、颈动脉成像和心脏检查分别在 20.3%、7.1%和 23.8%的患者中进行，至少有 1 项来自这 3 个类别的检查在 4.1%的患者中进行。有一半的患者住院治疗。增加住院治疗机会的因素包括（P<0.05）：年龄<45 岁；女性；吸烟史；就诊于大都市医院以及患有巨细胞动脉炎、颈动脉疾病、心房颤动、心脏瓣膜病、肥胖症、血脂异常、高血压、糖尿病和慢性缺血性心脏病。
大多数因 RAO 到 ED 就诊的患者未接受紧急脑部成像、颈动脉成像或基本心脏检查。需要采取多学科方法来提高认识，即 RAO 应被视为中风或中风等同物的前兆。
