Lin Mung Yan, Ray Hetal J, Pendley Andrew M, Bénard-Séguin Étienne, Okrent Smolar Avital Lily, Duran Mariana Rodriguez, Soto Mariam Torres, Shanmugam Nithya, McHenry Jessica, Berman Gabriele, Keadey Matthew T, Wright David W, Bruce Beau B, Newman Nancy J, Biousse Valérie
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, Virginia.
Ophthalmology. 2025 Jul;132(7):823-829. doi: 10.1016/j.ophtha.2025.01.024. Epub 2025 Jan 31.
Emergency department (ED) visits to rule out papilledema or for papilledema workup are increasing. Our goal was to evaluate whether implementation of a hybrid true color nonmydriatic fundus photography and OCT camera in our ED (NMFP-OCT) combined with a "papilledema protocol" could avoid in-person ophthalmology consultations and accelerate the evaluation for papilledema.
Prospective quality improvement study.
Adult patients who underwent NMFP-OCT camera examination in our ED from June 9, 2023, through June 30, 2024, to rule out papilledema or perform a papilledema workup.
We collected final diagnoses, ED lengths of stay, and whether an in-person ophthalmology consultation was performed in addition to remote interpretation of images. We compared ED lengths of stay with previous data prospectively collected in 2022 before installation of the NMFP-OCT camera in the ED.
Median ED length of stay in hours and number of patients in whom papilledema was ruled out remotely.
For patients referred to the ED for papilledema, the ED NMFP-OCT camera reduced the median ED length of stay to 12 hours (interquartile range, 7.5-26.5 hours; 337 patients) compared with 27 hours (interquartile range, 19-33 hours; 85 patients) in 2022 (P < 0.001). For the 199 patients in whom papilledema was ruled out with the NMFP-OCT camera, the ED length of stay decreased from 24.5 hours (interquartile range, 10-29 hours) in 2022 to 9 hours (interquartile range, 6.5-18.5 hours) after installation of the ED NMFP-OCT camera (P = 0.007); papilledema was ruled out remotely without in-person ophthalmology consultation in 185 of 199 patients (93%). For patients with previously known idiopathic intracranial hypertension, ED stay decreased from 24 hours in 2022 (interquartile range, 12-28 hours) to 10 hours after installation of the ED NMFP-OCT camera (interquartile range, 7.5-17 hours; 50 patients; P = 0.02).
Implementation of the NMFP-OCT camera in our general ED reduced the ED length of stay of patients being evaluated for papilledema by 56% and mostly avoided in-person ophthalmology consultations when papilledema was ruled out remotely on ocular imaging, reducing the burden on residents and on-call ophthalmologists.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
因排除视乳头水肿或对视乳头水肿进行检查而到急诊科（ED）就诊的人数正在增加。我们的目标是评估在我们的急诊科实施一台兼具真彩色非散瞳眼底照相和光学相干断层扫描（OCT）功能的混合相机（NMFP - OCT）并结合“视乳头水肿诊疗方案”是否能够避免面对面的眼科会诊，并加快对视乳头水肿的评估。
前瞻性质量改进研究。
2023年6月9日至2024年6月30日期间在我们急诊科接受NMFP - OCT相机检查以排除视乳头水肿或进行视乳头水肿检查的成年患者。
我们收集了最终诊断结果、急诊科停留时间，以及除了图像远程解读外是否进行了面对面的眼科会诊。我们将急诊科停留时间与2022年在急诊科安装NMFP - OCT相机之前前瞻性收集的先前数据进行了比较。
以小时为单位的急诊科停留时间中位数以及通过远程排除视乳头水肿的患者数量。
对于因视乳头水肿转诊至急诊科的患者，与2022年的27小时（四分位间距，19 - 33小时；85例患者）相比，急诊科的NMFP - OCT相机将急诊科停留时间中位数缩短至12小时（四分位间距，7.5 - 26.5小时；337例患者）（P < 0.001）。对于使用NMFP - OCT相机排除视乳头水肿的199例患者，急诊科停留时间从2022年的24.5小时（四分位间距，10 - 29小时）在安装急诊科NMFP - OCT相机后降至9小时（四分位间距，6.5 - 18.5小时）（P = 0.007）；199例患者中有185例（93%）通过远程排除了视乳头水肿，无需面对面的眼科会诊。对于先前已知患有特发性颅内高压的患者，急诊科停留时间从2022年的24小时（四分位间距，12 - 28小时）在安装急诊科NMFP - OCT相机后降至10小时（四分位间距，7.5 - 17小时；50例患者；P = 0.02）。
在我们的综合急诊科实施NMFP - OCT相机，将对视乳头水肿进行评估的患者的急诊科停留时间缩短了56%，并且在通过眼部成像远程排除视乳头水肿时，大多避免了面对面的眼科会诊，减轻了住院医师和值班眼科医生的负担。
在本文末尾的脚注和披露中可能会发现专有或商业披露信息。
