National Trends in Central Retinal Artery Occlusion Presentations and Stroke Workup in United States Emergency Department

Document Type

Journal Article

Publication Date

3-28-2025

Journal

American journal of ophthalmology

DOI

10.1016/j.ajo.2025.03.040

Keywords

Central Retinal Artery Occlusion; National Emergency Department Database; Stroke; Workup

Abstract

PURPOSE: To investigate trends in acute central retinal artery occlusion (CRAO) diagnostic assessments and sociodemographic characteristics of patients in the United States (US) emergency department (ED). DESIGN: Retrospective trend study. SUBJECTS: Adult patients with CRAO presenting to ED from 2016 through 2021. METHODS: The National Emergency Department Sample (NEDS) was queried with International Classification of Diseases, Tenth Revision (ICD-10) codes with a primary diagnosis of CRAO. Stroke workup modalities assessed included brain imaging (CT/CTA and MRI/MRA), carotid imaging (US, CTA, MRA), cardiac diagnostics (Echocardiogram/ECG), and laboratory workup (ESR/CRP). MAIN OUTCOME MEASURE: Proportion of studied participants receiving stroke workup modalities. RESULTS: 3,736 patients were identified with mean age of 69 [13.72] years, majority were male (53.02%), and predominantly insured by Medicare (62.77%). Comorbidities included hypertension (75.45%), hyperlipidemia (44.67%), coronary artery disease (20.26%), diabetes (27.38%), and obesity (11%). CRAO incidence significantly increased over the five-year period from 1,698 to 3,526 (p=0.024). Utilization rates of all workup modalities including brain imaging, carotid imaging, heart, and laboratory tests showed a linear increase from 2016 through 2021. The proportion of patients receiving no stroke workup decreased from 66.75% to 57.87% (p=0.259). CONCLUSIONS: The US has increased the screening and stroke workup of CRAO in the ED over time, yet greater than 50% of patients continue to not receive any type of stroke workup imaging. Greater awareness of these trends and current guidelines could result in improved screening and patient outcomes.

Department

School of Medicine and Health Sciences Student Works

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