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Abstract Details

Systematic “Papilledema Protocol” in an Emergency Department
Neurohospitalist
P9 - Poster Session 9 (5:00 PM-6:00 PM)
2-010

To report our >2-year experience evaluating patients' final diagnoses and usefulness of tests performed as part of our Emergency Department (ED) "Papilledema Protocol".
Increasing Neuro-ophthalmology consultations in the ED prompted implementation of a “Papilledema Protocol” to streamline evaluation of patients with signs/symptoms of intracranial hypertension and/or bilateral disc edema [protocol performed in our ED/Clinical Decision Unit (CDU): non-mydriatic color-fundus photography/OCT nerve/macula (NMFP-OCT) by ED-staff/remote interpretation by Ophthalmology; Neurology/Neuro-ophthalmology consultations; contrast-MRI brain/orbits; MR-Venogram; lumbar puncture (CSF-opening pressure/analysis); blood pressure; CBC, ±syphilis testing].
Prospective quality improvement project of consecutive ED-patients with “Papilledema Protocol” from 6/14/2023-9/21/2025. We collected patient demographics, referral patterns, ancillary testing, final diagnoses, ED/CDU length-of-stay, disposition.

318 patients with remote diagnosis of “papilledema” on NMFP-OCT underwent “Papilledema Protocol” in our ED/CDU.

Referral patterns: presumed papilledema found by outside eye-care-providers (228;72%); papilledema found in our eye clinic (14;4%); symptoms/signs suggesting intracranial hypertension (75;24%); incidental bilateral disc edema in fungemia (1;0.3%).

211 (66.4%) were discharged home from the ED/CDU [median length-of-stay 27.9 hours, IQR,24.6-32.2]; 107 (33.6%) were admitted to the hospital.   

Final diagnoses: idiopathic intracranial hypertension (223;70%) (6 fulminant IIH); cerebral venous thrombosis (7;2.2%); intracranial mass (3;0.9%); subdural hematoma (1); obstructive hydrocephalus (4;1.3%); CSF shunt malfunction (2;0.6%); leptomeningeal process (10;3.1%); stage-IV hypertensive retinopathy (7;2.2%); other anterior optic neuropathies (36;11.3%); pseudopapilledema (24;7.5%).

Workup obtained in the ED: head-CT (157;49.4%); contrast MRI-brain/orbits (254;79.9%); MRI-brain only (31;9.7%); head-MRV (272;85.5%); LP in ED (263;82.7%); 317 CBC.

309/318 (97%) patients required outpatient neuro-ophthalmology follow-up; 4 (1.2 %) patients returned to the ED for same concern within 30 days.

Remote interpretation of NMFP-OCT obtained in the ED allowed for rapid trigger of “Papilledema Protocol” and expedited care. 77/318 (24.2%) patients with “Papilledema Protocol” in our ED/CDU were diagnosed with severe disorders; 33.6% required admission to the hospital. Only 1.2% of patients returned to the ED within 30 days
Authors/Disclosures
Valerie Biousse, MD
PRESENTER 		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.
Mung Yan Lin, MD Dr. Lin has nothing to disclose.
Kevin Yan, MD 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.
Stuart J. Duffield Mr. Duffield 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 $5,000-$9,999 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 Eli Lilly. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Phelcom. The institution of Dr. Newman has received research support from GenSight. 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.