Nonmydriatic ocular fundus photography among headache patients in an emergency department.

Abstract:

OBJECTIVES:Determine the frequency of and the predictive factors for abnormal ocular fundus findings among emergency department (ED) headache patients. METHODS:Cross-sectional study of prospectively enrolled adult patients presenting to our ED with a chief complaint of headache. Ocular fundus photographs were obtained using a nonmydriatic fundus camera that does not require pupillary dilation. Demographic and neuroimaging information was collected. Photographs were reviewed independently by 2 neuroophthalmologists for findings relevant to acute care. The results were analyzed using univariate statistics and logistic regression modeling. RESULTS:We included 497 patients (median age: 40 years, 73% women), among whom 42 (8.5%, 95% confidence interval: 6%-11%) had ocular fundus abnormalities. Of these 42 patients, 12 had disc edema, 9 had optic nerve pallor, 6 had grade III/IV hypertensive retinopathy, and 15 had isolated retinal hemorrhages. Body mass index ≥ 35 kg/m(2) (odds ratio [OR]: 2.3, p = 0.02), younger age (OR: 0.7 per 10-year increase, p = 0.02), and higher mean arterial blood pressure (OR: 1.3 per 10-mm Hg increase, p = 0.003) were predictive of abnormal retinal photography. Patients with an abnormal fundus had a higher percentage of hospital admission (21% vs 10%, p = 0.04). Among the 34 patients with abnormal ocular fundi who had brain imaging, 14 (41%) had normal imaging. CONCLUSIONS:Ocular fundus abnormalities were found in 8.5% of patients with headache presenting to our ED. Predictors of abnormal funduscopic findings included higher body mass index, younger age, and higher blood pressure. Our study confirms the importance of funduscopic examination in patients with headache, particularly in the ED, and reaffirms the utility of nonmydriatic fundus photography in this setting.

journal_name

Neurology

journal_title

Neurology

authors

Thulasi P,Fraser CL,Biousse V,Wright DW,Newman NJ,Bruce BB

doi

10.1212/WNL.0b013e31827f0f20

subject

Has Abstract

pub_date

2013-01-29 00:00:00

pages

432-7

issue

5

eissn

0028-3878

issn

1526-632X

pii

WNL.0b013e31827f0f20

journal_volume

80

pub_type

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