Evaluation of acute visual changes in the pediatric emergency department: Etiologies and red flags.
Among children imaged for acute visual changes, 35% had pathologic neuroimaging findings
Evaluation of acute visual changes in the pediatric emergency department: Etiologies and red flags.
Acute visual changes-including blurred vision, diplopia, photopsia, visual hallucinations, and vision loss-pose a diagnostic challenge in children due to limited symptom description and limited cooperation during examination.
We aimed to (1) characterize the etiologies of children presenting to a pediatric emergency department (pediatric emergency department) with acute visual changes and (2) identify clinical predictors of pathologic neuroimaging findings.
Aged 1 month to 18 years were identified through structured chief complaint fields and keyword searches of electronic medical records (e.g., "blurred vision," "vision loss," "double vision").
We included 444 patients in the study.
The most common etiologies were neurological (29%), ocular (23%), and systemic (18%).
Vision loss, pain with eye movements, focal neurological deficits, signs of meningeal irritation, dysmetria, tremor, papilledema, abnormal pupillary light reflexes, and a positive Romberg sign were significantly more frequent among patients with pathologic neuroimaging findings (p < 0.001).
Although most pediatric acute visual changes are benign, a clinically important proportion are associated with significant neuroimaging abnormalities.
Specific neurological examination findings may help identify children at higher risk for intracranial pathology.
Prospective multicenter studies are needed to validate these predictors and refine imaging strategies in the pediatric emergency department.