Referral Patterns of Central Retinal Artery Occlusion to an Academic Center Affiliated With a Stroke Center
| Autor: | Valérie Biousse, Alexis M. Flowers, Beau B. Bruce, Wesley Chan, Benjamin I. Meyer, Nancy J. Newman |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Pediatrics medicine.medical_specialty Retinal Artery Occlusion Article Tertiary Care Centers symbols.namesake Young Adult Interquartile range medicine Outpatient clinic Humans Stroke Referral and Consultation Fisher's exact test Aged Retrospective Studies Aged 80 and over business.industry Medical record Retrospective cohort study Emergency department Middle Aged medicine.disease Ophthalmology symbols Central retinal artery occlusion Female Neurology (clinical) business |
| Zdroj: | J Neuroophthalmol |
| ISSN: | 1536-5166 |
| Popis: | OBJECTIVE: Central retinal artery occlusion (CRAO) is a medical emergency and patients who present acutely should be immediately referred to the nearest stroke center. We evaluated practice patterns for CRAO management at one academic center over the last decade. DESIGN: Retrospective study. PARTICIPANTS: All adult patients diagnosed with a CRAO seen at one tertiary hospital and outpatient clinic affiliated with a comprehensive stroke center (“our institution”) from 2010–2020. METHODS: Our electronic medical records were searched for CRAO diagnoses and patient medical records were reviewed. Exclusion criteria were incorrect diagnosis, unclear diagnosis, historical CRAO, or satellite clinic location. Demographics, distance and time to presentation to our institution, number and type of prior providers seen, diagnostic tests performed, and treatments provided were collected. Summary statistics of median, mean, and frequency were calculated and reported with measures of variance (interquartile range [IQR], ranges). F, Tukey’s and Fisher’s exact tests were used for comparisons. MAIN OUTCOME MEASURE: Referral patterns of patients with CRAO RESULTS: Among 606 patients identified in our medical records with a diagnosis of CRAO, 181 were included [80 (44.2%) women; median age 69 years (range 20–101)]. Median distance from patient’s home to our institution was 27.8 miles (IQR 15.5–57.4; range 2.4–930). Median time from visual loss to presentation at our institution was 144 hours (IQR 23–442 hours, range 0.5–2920) from 2010–2013; 72 hours (IQR 10.5–372 hours, range 0–13140) from 2014–2016; and 48 hours (IQR 7–180 hours, range 0–8030) from 2017–2020 (p = 0.07). 91/181 (50%) patients presented to an outpatient provider. 73/181 (40%) presented to an emergency department (ED). 86% presented within 1 week of visual loss onset, and rates of comprehensive inpatient evaluation for acute CRAO improved from 44% in 2010–2013 to 82% in 2017–2020 (p < 0.01). CONCLUSION: Patients with CRAO often present late and only after evaluation by multiple outpatient providers. Improvement has occurred over the past decade, but delays underscore the barriers to performing clinical trials evaluating very acute treatments for CRAO. Educational interventions for healthcare providers and patients are necessary. |
| Databáze: | OpenAIRE |
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