Low percentage of patients with retinal artery occlusions receive stroke workups

This study used emergency department (ED) imaging data to determine how many patients with a retinal artery occlusion (RAO) were receiving recommended stroke workups.

Study design

This retrospective cross-sectional study looked at data from the National Emergency Department Sample database from 2006 through 2014 and used multivariate analysis to determine rates of different aspects of the embolic workup.

Outcomes

Although the current recommendations specify that physicians refer patients with an RAO to the ED for immediate stroke workup, this study found that brain imaging was performed in 20.3% of patients, carotid imaging in 7.1% of patients, and cardiac testing in 23.8% of patients. Only 33% of patients had at least 1 type of imaging for all 3 categories—the brain, carotids, and cardiac.

Limitations

This is a database study, so there are limits to the types of data collected and how those data are categorized. There is also no way to perform subanalysis on the ED stroke level status, or on patients self-referred to the ED for vision loss vs those referred for stroke workup by an ophthalmologist.

Clinical significance

This retrospective database study suggests that patients with an RAO are not being worked up for stroke, despite the current guidelines to do so. In this study, the majority of the patients did not receive a complete stroke evaluation of the brain, carotids, nor cardiac system. More research and education may be needed to increase awareness and ensure patients are receiving the recommended care.