The role of fundoscopy in pediatric seizures

Area of Science:

• Pediatric Neurology
• Ophthalmology
• Emergency Medicine

Background:

• Fundoscopy is a clinical tool that can inform decisions regarding neuroimaging in pediatric patients.
• Increased intracranial pressure (ICP) may present with symptoms other than seizures, and fundoscopy can detect papilledema, a sign of elevated ICP.
• Performing fundoscopy in children requires specific expertise, time, and patient cooperation.

Purpose of the Study:

• To evaluate the rate of abnormal neuroimaging after fundoscopy in children presenting with seizures to the pediatric emergency department (PED).
• To assess the diagnostic yield and accuracy of fundoscopy in identifying significant intracranial pathology in this patient population.

Main Methods:

• Retrospective, single-center study analyzing data from 646 pediatric patients diagnosed with seizures.
• Fundoscopic examinations were performed, and outcomes related to papilledema findings and neuroimaging results were recorded.
• The rate of repeat fundoscopies due to inconclusive initial examinations was also determined.

Main Results:

• Only 3 out of 646 patients (0.46%) were initially diagnosed with papilledema.
• Of those with papilledema, only one patient had an abnormal brain CT, with a history of prior diagnosis and neuroimaging recommendation.
• Approximately 7.6% of patients required a second fundoscopic evaluation due to an inconclusive initial finding.

Conclusions:

• Fundoscopy in the pediatric emergency department setting has a limited yield and questionable accuracy for children presenting with seizures.
• The low incidence of papilledema and abnormal neuroimaging suggests that fundoscopy may not be a highly effective tool for guiding neuroimaging decisions in this context.
• Further research may be needed to establish the optimal role of fundoscopy in the evaluation of pediatric seizures.