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Abstract Details

Non-mydriatic Ocular Fundus Imaging on Consecutive Headache Patients in an Emergency Department (ED)
Neuro-ophthalmology/Neuro-otology
S14 - Neuro-ophthalmology/Neuro-otology (11:27 AM-11:39 AM)
002

Our goal was to determine how often non-mydriatic ocular fundus photographs with OCT (NMFP-OCT) show relevant fundus findings in a consecutive cohort of patients with headaches in a general ED.
Papilledema is a red-flag in the evaluation of headache but is often missed in EDs where ocular fundus examination is rarely performed.

Quality improvement project, prospective over 16 consecutive days/nights. NMFP-OCT OU [table-top Maestro2/Topcon-Japan] was ordered for all patients presenting to our ED with headaches [as primary (Group1) or secondary complaint (Groups2/3)], or with history of headaches of any kind (Group4). Demographic information, headache classification, final diagnosis and NMFP-OCT findings were collected.

Of 1838 ED visits over 16 days/nights, 194 patients had headaches and 149 underwent NMFP-OCT in the ED. Group1: 46 patients presented for isolated headache evaluation/treatment; 40 had NMFP-OCT [1 papilledema, 1 dilated retinal vessels from carotid-cavernous fistula, 2 non-relevant findings]; 6 patients without NMFP-OCT in the ED [1 unable to sit, 4 discharged prior, 1 refused]. Group2: 46 patients presented for a neurologic/neurosurgical issue with associated headache; 37 had NMFP-OCT [4 papilledema, 4 relevant retinopathies, 2 optic atrophy, 7 non-relevant findings]; 9 patients without NMFP-OCT in the ED [6 unable to sit, 3 admitted/discharged prior). Group3: 77 patients presented for a non-neurologic issue and had headache; 52 had NMFP-OCT and none had papilledema. Group4: 25 patients with previous history of headache but no active headache (3 with neurologic/neurosurgical issue, 22 with non-neurologic/neurosurgical issue); 20 had NMFP-OCT [no papilledema, 1 optic atrophy].
NMFP-OCT obtained in the ED in consecutive patients with active headaches allowed for rapid diagnosis of papilledema in 5/86 (5.8%) and other relevant findings in 8/86 (9.3%), with 15 (17.5%) not having NMFP-OCT in the ED. None of the patients with headaches or history of headaches who presented to the ED for other reasons had papilledema. 
Authors/Disclosures
Kevin Yan, MD
PRESENTER 		An immediate family member of Dr. Yan has received personal compensation in the range of $100,000-$499,999 for serving as a Pharmaceutical Reviewer with US Food and Drug Administration.
George Alencastro, MD Dr. Alencastro has nothing to disclose.
Andrew Pendley No disclosure on file
Nithya Shanmugam, Medical Student Ms. Shanmugam has nothing to disclose.
Jessica McHenry Ms. McHenry has nothing to disclose.
Stuart J. Duffield Mr. Duffield has nothing to disclose.
Daniel V. Adamkiewicz, MD Dr. Adamkiewicz has nothing to disclose.
Duyen Vo, MD Dr. Vo has nothing to disclose.
Jordan Prosky Mr. Prosky has nothing to disclose.
Matthew Keadey, MD Dr. Keadey has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for The Weathington Firm, LLC.
David Wright (Emory) David Wright has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott. David Wright has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astrocyte Pharmaceutical . David Wright has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for several defense legal firms. David Wright has stock in Astrocyte Pharmaceuticals. The institution of David Wright has received research support from NINDS. The institution of David Wright has received research support from Department of Defense. The institution of David Wright has received research support from Marcus Foundation. The institution of David Wright has received research support from Nico Corporation. The institution of David Wright has received research support from Center for Disease Control. David Wright has received intellectual property interests from a discovery or technology relating to health care.
Michael Dattilo, MD, PhD Dr. Dattilo has nothing to disclose.
Andrew Fischer, MD An immediate family member of Dr. Fischer has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for BrainQ Technologies.
Mung Yan Lin, MD Dr. Lin has nothing to disclose.
Nancy J. Newman, MD, FAAN (Emory University School of Medicine) Dr. Newman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GenSight. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Chiesi. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Stoke. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurophth. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lilly. The institution of Dr. Newman has received research support from GenSight. The institution of Dr. Newman has received research support from Santhera. The institution of Dr. Newman has received research support from NINDS/NIH. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care.
Valerie Biousse, MD Dr. Biousse has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gensights Biologic. Dr. Biousse has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Topcon. Dr. Biousse has received publishing royalties from a publication relating to health care. Dr. Biousse has received publishing royalties from a publication relating to health care.