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

• Published in: American journal of ophthalmology Vol. 276; pp. 40 - 49
• Main Authors: Akosman, Sinan, Yuan, Sean M., Leigh, Arnold, Li, Renxi, Luo, Renjie, Asahi, Masumi G., Mishra, Kapil
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2025
• Subjects: Adult; Aged; Aged, 80 and over; Computed Tomography Angiography; Emergency Service, Hospital - statistics & numerical data; Emergency Service, Hospital - trends; Female; Humans; Incidence; Magnetic Resonance Angiography; Male; Middle Aged; Retinal Artery Occlusion - diagnosis; Retinal Artery Occlusion - epidemiology; Retrospective Studies; Stroke - diagnosis; Stroke - epidemiology; United States - epidemiology; United States; CRP; OCT; CRAO; NEDS; GCA; TPA; ESR; MRI; ECG; AAO; CT; CTA; AHA; MRA; ED
• ISSN: 0002-9394; 1879-1891; 1879-1891
• DOI: 10.1016/j.ajo.2025.03.040

•Doubling in the incidence of ED presentations for CRAO between 2016 and 2021.•A linear increase in utilization for stroke workup imaging modalities in the ED.•Despite AAO/AHA guidelines, >50% of CRAO patients received no stroke workup imaging. 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). Retrospective trend study. Adult patients with CRAO presenting to ED from 2016 through 2021. The National Emergency Department Sample 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/computed tomography angiography and magnetic resonance imaging/magnetic resonance angiography), carotid imaging (US, computed tomography angiography, magnetic resonance angiography), cardiac diagnostics (echocardiogram/electrocardiogram), and laboratory workup (erythrocyte sedimentation rate/C-reactive protein). Proportion of studied participants receiving stroke workup modalities. A total of 3736 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 5-year period from 1698 to 3526 (P = .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 = .259). 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.