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• W4381144695 abstract "<h3>Objectives</h3> A number of high profile cases of missed papilloedema during high street optometrist examination led to an increase in referrals of Children and Young People (CYPs) with suspected papilloedema to the paediatric services (general paediatrics or paediatric emergency department) of WCUH. Many patients were admitted and had cranial imaging or lumbar puncture, both reported as normal and were subsequently examined by a paediatric ophthalmologist who did not confirm the clinical finding of papilloedema. This led to significant pressures on inpatient beds and the MRI department, as well as anxiety and discomfort for families. We designed a pathway addressing this issue and retrospectively collected data to demonstrate its effectiveness in reducing unnecessary admissions and investigations. <h3>Methods</h3> Data on patients admitted with suspected papilloedema over a period of 6 months (1/09/2020–1/03/2021) were collected retrospectively through review of electronic notes. Papilloedema pathway suggesting early access to paediatric ophthalmology prior to other investigations in the absence of red flags was introduced (Chart1). Data on patients referred to ophthalmology following pathway introduction were collected between 25/06/2021 and 1/03/2022. Further intervention, including staff education and improved access to urgent ophthalmology input, was implemented. Patient data were collected again between 5/04/2022 and 16/06/2022. <h3>Results</h3> Of the 13 patients notes initially reviewed, all had an MRI head, 1 under general anaesthetic. 54% had a lumbar puncture. 54% had papilloedema confirmed on paediatric ophthalmology assessment, 27% had a neurological condition (1 – multiple sclerosis, 1 – optic neuritis, 2 – idiopathic intracranial hypertension- IIH). All the patients with confirmed pathology either had abnormal neurological examination findings or red flags in history on presentation. Following stage 1 intervention, 11 CYPs were referred to paediatric services with papilloedema. 54% had an MRI, none had abnormalities on imaging. All had paediatric ophthalmology assessment, all over 3 months after initial referral, with only 1 confirmed papilloedema. 1 had a lumbar puncture, without a conclusive diagnosis of IIH. Following stage 2 intervention, 12 CYPs were referred. 33% had MRIs, which were all normal. None had a lumbar puncture. All were seen by paediatric ophthalmology within 3 months of initial referral and none had confirmed papilloedema. <h3>Conclusion</h3> The volume of referrals for suspected papilloedema from high street opticians is high and increasing. Our pathway is an effective tool to allow clinicians to identify those CYPs that need urgent admission for inpatient investigations and to direct all others to urgent outpatient paediatric ophthalmology assessment." @default.
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• W4381144695 date "2023-06-19" @default.
• W4381144695 modified "2023-09-27" @default.
• W4381144695 title "367 Implementation of papilloedema pathway to optimise the management of 0–16 year olds referred to Whipps Cross University Hospital (WCUH)" @default.
• W4381144695 doi "https://doi.org/10.1136/archdischild-2023-rcpch.308" @default.
• W4381144695 hasPublicationYear "2023" @default.
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