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The yield of ophthalmoscopy as a screening tool for intracranial pathology in pediatric headache
Rawan Azzam Kawar1, Itai Gross2, Yael Biro3
1Department of Pediatrics, Hadassah and The Hebrew University Medical Center, Jerusalem, Israel.
Insights
Ophthalmoscopy for papilledema in children with headaches is a valuable screening tool. This study found high sensitivity and specificity, confirming its importance in pediatric emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Ophthalmology
- Neurology
Background:
- Headache is a frequent pediatric emergency department (PED) complaint.
- Rapid exclusion of serious intracranial pathologies like tumors and idiopathic intracranial hypertension (IIH) is crucial.
- Ophthalmoscopy for papilledema is a common but poorly validated screening tool for these conditions.
Purpose of the Study:
- To evaluate the diagnostic yield of ophthalmoscopy for papilledema in children presenting with headache to the PED.
- To determine the sensitivity and specificity of papilledema for detecting intracranial pathology in this population.
Main Methods:
- Retrospective analysis of medical records for children aged 2-18 years presenting with headache between 2007 and 2017.
- Inclusion of clinical, demographic, radiographic, and laboratory data.
- Analysis of ophthalmoscopy findings, specifically papilledema, and correlation with diagnosed intracranial pathologies.
Main Results:
- Of 948 children with headaches, 536 underwent ophthalmoscopy. Forty-one had papilledema, including 7 with intracranial tumors and 15 with IIH.
- Papilledema showed 70% sensitivity and 93.5% specificity for intracranial tumors.
- Overall intracranial pathology sensitivity was 61.1% and specificity 96.2%.
Conclusions:
- Ophthalmoscopy for papilledema demonstrates high sensitivity and specificity in children with headaches presenting to the PED.
- This reinforces the utility of ophthalmoscopy as an important screening tool for identifying serious intracranial conditions in pediatric patients.
- The findings support the continued use of ophthalmoscopy in the initial assessment of pediatric headaches.
Abstract:
Headache is a common complaint in children who present at the pediatric emergency department (PED). Serious conditions such as intracranial tumors and idiopathic intracranial hypertension (IIH) should be rapidly ruled out. Ophthalmoscopy for the presence of papilledema has long been considered critical to the assessment of headaches in children; however, the yield of this procedure is poorly validated. This retrospective study implemented a computerized search of the medical records of a single tertiary center to identify all children aged 2-18 years who presented at the PED complaining of headache between 2007 and 2017. The clinical, demographic, radiographic, and laboratory data were analyzed. Of the 948 children aged 2-18 years who presented at the PED complaining of headache, 536 had an ophthalmoscopy examination carried out by an ophthalmologist. Forty-one had papilledema, of whom 7 had an intracranial tumor, 15 had IIH, and 9 had optic nerve head drusen. Of the 495 children without papilledema, 3 had intracranial tumor, and 11 had IIH. The sensitivity and specificity of papilledema for the diagnosis of intracranial tumor were 70% and 93.5%, respectively, with an NPV and PPV of 99.4% and 17.1%, respectively. The sensitivity and specificity of papilledema for the diagnosis of intracranial pathology in general were 61.1% and 96.2%, respectively, with an NPV and PPV of 97.2% and 53.7%, respectively. Conclusion: Assessment by ophthalmoscopy for papilledema in children presenting to the PED with headache had high sensitivity and high specificity, thus reinforcing the importance of ophthalmoscopy as a screening tool in these children. What is Known: • Headache is a common complaint in children. Serious intracranial pathologies need to be rapidly excluded. • Ophthalmoscopy for the presence of papilledema is commonly used as a screening tool for intracranial pathology, but this procedure is poorly validated. What is New: • Ophthalmoscopy for the assessment of papilledema in children who present with headache to the pediatric emergency department is shown to exhibit sensitivity and specificity for the diagnosis of intracranial pathology.
