Kawar Rawan Azzam, Gross Itai, Biro Yael, Guzner Noa, Peyser-Rosenberg Moriah, Azulai Shira, Mechulam Hadas, Gilboa Tal, Cohen Hodaya, Hashavya Saar
Department of Pediatrics, Hadassah and The Hebrew University Medical Center, Jerusalem, Israel.
Department of Pediatric Emergency Medicine, Hadassah and The Hebrew University Medical Center, Jerusalem, Israel.
Eur J Pediatr. 2023 Feb;182(2):609-614. doi: 10.1007/s00431-022-04708-0. Epub 2022 Nov 19.
Headache is a common complaint in children who present at the pediatric emergency department (PED). Serious conditions such as intracranial tumors and idiopathic intracranial hypertension (IIH) should be rapidly ruled out. Ophthalmoscopy for the presence of papilledema has long been considered critical to the assessment of headaches in children; however, the yield of this procedure is poorly validated. This retrospective study implemented a computerized search of the medical records of a single tertiary center to identify all children aged 2-18 years who presented at the PED complaining of headache between 2007 and 2017. The clinical, demographic, radiographic, and laboratory data were analyzed. Of the 948 children aged 2-18 years who presented at the PED complaining of headache, 536 had an ophthalmoscopy examination carried out by an ophthalmologist. Forty-one had papilledema, of whom 7 had an intracranial tumor, 15 had IIH, and 9 had optic nerve head drusen. Of the 495 children without papilledema, 3 had intracranial tumor, and 11 had IIH. The sensitivity and specificity of papilledema for the diagnosis of intracranial tumor were 70% and 93.5%, respectively, with an NPV and PPV of 99.4% and 17.1%, respectively. The sensitivity and specificity of papilledema for the diagnosis of intracranial pathology in general were 61.1% and 96.2%, respectively, with an NPV and PPV of 97.2% and 53.7%, respectively. Conclusion: Assessment by ophthalmoscopy for papilledema in children presenting to the PED with headache had high sensitivity and high specificity, thus reinforcing the importance of ophthalmoscopy as a screening tool in these children. What is Known: • Headache is a common complaint in children. Serious intracranial pathologies need to be rapidly excluded. • Ophthalmoscopy for the presence of papilledema is commonly used as a screening tool for intracranial pathology, but this procedure is poorly validated. What is New: • Ophthalmoscopy for the assessment of papilledema in children who present with headache to the pediatric emergency department is shown to exhibit sensitivity and specificity for the diagnosis of intracranial pathology.
头痛是儿科急诊科（PED）就诊儿童的常见主诉。诸如颅内肿瘤和特发性颅内高压（IIH）等严重病症应迅速排除。长期以来，通过检眼镜检查是否存在视乳头水肿一直被认为对评估儿童头痛至关重要；然而，这一检查方法的有效性尚未得到充分验证。这项回顾性研究对一家单一三级中心的病历进行了计算机检索，以确定2007年至2017年间在PED就诊并主诉头痛的所有2至18岁儿童。对临床、人口统计学、影像学和实验室数据进行了分析。在948例2至18岁主诉头痛并在PED就诊的儿童中，536例由眼科医生进行了检眼镜检查。41例有视乳头水肿，其中7例有颅内肿瘤，15例有IIH，9例有视神经乳头玻璃疣。在495例无视乳头水肿的儿童中，3例有颅内肿瘤，11例有IIH。视乳头水肿诊断颅内肿瘤的敏感性和特异性分别为70%和93.5%，阴性预测值和阳性预测值分别为99.4%和17.1%。视乳头水肿诊断一般颅内病变的敏感性和特异性分别为61.1%和96.2%，阴性预测值和阳性预测值分别为97.2%和53.7%。结论：对因头痛就诊于PED的儿童进行检眼镜检查视乳头水肿具有高敏感性和高特异性，从而强化了检眼镜检查作为这些儿童筛查工具的重要性。已知信息：•头痛是儿童的常见主诉。严重的颅内病变需要迅速排除。•通过检眼镜检查是否存在视乳头水肿通常用作颅内病变的筛查工具，但这一检查方法的有效性尚未得到充分验证。新发现：•对因头痛就诊于儿科急诊科的儿童进行检眼镜检查视乳头水肿，显示出对颅内病变诊断的敏感性和特异性。
