Hoyer Carolin, Winzer Simon, Matthé Egbert, Heinle Ida, Sandikci Vesile, Nabavi Darius, Platten Michael, Puetz Volker, Szabo Kristina
Department of Neurology and Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
Neurol Res Pract. 2022 Aug 1;4(1):30. doi: 10.1186/s42466-022-00193-w.
Central retinal artery occlusion (CRAO) is a neuro-ophthalmological emergency whose optimal management is still under debate and due to the absence of definite guidelines, practice is expected to vary. We aimed to characterize early evaluation as well as acute treatment and diagnostic approaches in German hospitals with a stroke unit (SU).
In 07/2021, all 335 certified German SUs were invited to participate in an anonymous online survey endorsed by the German Stroke Society on emergency department care organization, diagnostic procedures, and treatment of patients with unilateral vision loss (UVL) subsequently diagnosed with CRAO.
One hundred and sixty-three (48.6%) of the 335 eligible centers responded. Most (117/135; 86.7%) stated that UVL patients were treated as an emergency, in 62/138 (44.9%) hospitals according to specific guidelines. First-line evaluation was performed by neurologists in 85/136 (62.5%) hospitals, by ophthalmologists in 43/136 (31.6%) hospitals. Seventy of 135 (51.9%) respondents indicated a lack of on-site ophthalmological expertise. Seventy-four of 129 (57.4%) respondents performed thrombolysis in CRAO and 92/97 (94.8%) stated that patients with CRAO-if admitted to neurology-were treated on a SU.
Our findings reflect notable heterogeneity in early intrahospital care of CRAO in German SUs but demonstrate a preference for work-up and management as acute stroke by the involved neurologists. Streamlining interdisciplinary emergency evaluation is essential for ongoing and future prospective trials.
视网膜中央动脉阻塞（CRAO）是一种神经眼科急症，其最佳治疗方案仍存在争议，由于缺乏明确的指南，实际操作可能存在差异。我们旨在描述德国设有卒中单元（SU）的医院中对CRAO的早期评估、急性治疗及诊断方法。
2021年7月，邀请了德国所有335个认证的卒中单元参与一项由德国卒中协会认可的匿名在线调查，内容涉及急诊科护理组织、诊断程序以及对随后被诊断为CRAO的单眼视力丧失（UVL）患者的治疗。
335个符合条件的中心中有163个（48.6%）做出了回应。大多数（117/135；86.7%）表示UVL患者被作为急症治疗，在62/138（44.9%）的医院是根据特定指南进行治疗。在85/136（62.5%）的医院中，一线评估由神经科医生进行，在43/136（31.6%）的医院中由眼科医生进行。135名受访者中有70名（51.9%）表示缺乏现场眼科专业知识。129名受访者中有74名（57.4%）对CRAO患者进行了溶栓治疗，92/97（94.8%）表示CRAO患者 - 如果入住神经科 - 在卒中单元接受治疗。
我们的研究结果反映了德国卒中单元对CRAO进行早期院内护理时存在显著异质性，但表明相关神经科医生倾向于将其作为急性卒中进行检查和管理。简化跨学科紧急评估对于正在进行及未来的前瞻性试验至关重要。
