Abstract：
Suspected optic disc swelling is a common presentation in children. The delineation between true optic disc swelling and pseudopapilloedema, its common masquerade, requires careful evaluation. A streamlined pathway is required to avoid unnecessary investigations.
Papilloedema requires urgent neuroimaging, however, perceived optic disc swelling is not always true papilloedema. This study aims to investigate the outcome of referrals for optic disc swelling and formulate features that may assist in investigation and diagnosis.
A retrospective review of referrals for optic disc swelling to the Queensland Children\'s Hospital, Australia, between January 2014 and June 2020 was undertaken.
Four hundred and ten children were referred for optic disc swelling. Sixty-six patients were confirmed with optic disc swelling, and 344 patients had pseudopapilloedema. The average age was 10.10 ± 3.57 and 9.90 ± 3.50 years, respectively. The most common aetiology of optic disc swelling was idiopathic intracranial hypertension (n = 25). Optic disc drusen constituted the majority of pseudopapilloedema (n = 239) and the remainder were crowded/tilted discs (n = 105). True optic disc swelling patients were more likely to experience headache (OR = 8.68, p < 0.01) and visual disturbance (OR = 2.14, p = 0.03). B-scan was the most sensitive for the detection of optic disc drusen (100%), followed by optical coherence tomography (70.38%) and fundus autofluorescence (44.86%). The retinal nerve fibre layer thickness was significantly thicker in true optic disc swelling compared to pseudopapilloedema (p < 0.01). Twenty-two (33.33%) true optic disc swelling patients and 33 (9.59%) pseudopapilloedema patients underwent neuroimaging prior to ophthalmology review.
Suspected optic disc swelling in children is most likely pseudopapilloedema. Referrals should include neurological assessment, visual acuity, fundus photography, and optical coherence tomography to assist in the triage for ophthalmic review. Neuroimaging prior to ophthalmic review should be discouraged for children without neurological symptoms.
Papilloedema requires urgent neuroimaging, however, perceived optic disc swelling is not always true papilloedema. This study aims to investigate the outcome of referrals for optic disc swelling and formulate features that may assist in investigation and diagnosis.
A retrospective review of referrals for optic disc swelling to the Queensland Children\'s Hospital, Australia, between January 2014 and June 2020 was undertaken.
Four hundred and ten children were referred for optic disc swelling. Sixty-six patients were confirmed with optic disc swelling, and 344 patients had pseudopapilloedema. The average age was 10.10 ± 3.57 and 9.90 ± 3.50 years, respectively. The most common aetiology of optic disc swelling was idiopathic intracranial hypertension (n = 25). Optic disc drusen constituted the majority of pseudopapilloedema (n = 239) and the remainder were crowded/tilted discs (n = 105). True optic disc swelling patients were more likely to experience headache (OR = 8.68, p < 0.01) and visual disturbance (OR = 2.14, p = 0.03). B-scan was the most sensitive for the detection of optic disc drusen (100%), followed by optical coherence tomography (70.38%) and fundus autofluorescence (44.86%). The retinal nerve fibre layer thickness was significantly thicker in true optic disc swelling compared to pseudopapilloedema (p < 0.01). Twenty-two (33.33%) true optic disc swelling patients and 33 (9.59%) pseudopapilloedema patients underwent neuroimaging prior to ophthalmology review.
Suspected optic disc swelling in children is most likely pseudopapilloedema. Referrals should include neurological assessment, visual acuity, fundus photography, and optical coherence tomography to assist in the triage for ophthalmic review. Neuroimaging prior to ophthalmic review should be discouraged for children without neurological symptoms.
摘要：
未经授权：疑似视神经盘肿胀是儿童常见表现。真实的视盘肿胀和假乳头水肿之间的界限，它常见的化装舞会，需要仔细评估。需要简化的途径以避免不必要的调查。
未经证实：乳头状水肿需要紧急神经影像学检查，然而,视神经盘肿胀并不总是真正的乳头水肿。这项研究旨在调查转诊视盘肿胀的结果，并制定可能有助于调查和诊断的特征。
UNASSIGNED：对昆士兰儿童医院视盘肿胀转诊的回顾性审查，澳大利亚,在2014年1月至2020年6月期间进行。
UNASSIGNED：四百名儿童因视盘肿胀而转诊。66例患者被证实患有视神经盘肿胀,344例患者出现假乳头水肿。平均年龄10.10±3.57岁,9.90±3.50岁,分别。视盘肿胀最常见的病因是特发性颅内高压（n=25）。视盘玻璃疣构成了假性视盘水肿的大部分（n=239），其余为拥挤/倾斜的视盘（n=105）。真正的视盘肿胀患者更容易出现头痛（OR=8.68，p<0.01）和视觉障碍（OR=2.14，p=0.03）。B扫描对视盘玻璃疣的检测最敏感（100％），其次是光学相干断层扫描（70.38％）和眼底自发荧光（44.86％）。与假乳头水肿相比，真实视盘肿胀的视网膜神经纤维层厚度明显更厚（p<0.01）。22例（33.33％）真实的视盘肿胀患者和33例（9.59％）假乳头水肿患者在眼科检查之前接受了神经影像学检查。
未经证实：儿童疑似视神经盘肿胀很可能是假性示波水肿。转诊应包括神经系统评估，视敏度,眼底摄影,和光学相干断层扫描，以协助眼科检查的分诊。对于没有神经系统症状的儿童，应不鼓励在眼科检查之前进行神经影像学检查。
未经证实：乳头状水肿需要紧急神经影像学检查，然而,视神经盘肿胀并不总是真正的乳头水肿。这项研究旨在调查转诊视盘肿胀的结果，并制定可能有助于调查和诊断的特征。
UNASSIGNED：对昆士兰儿童医院视盘肿胀转诊的回顾性审查，澳大利亚,在2014年1月至2020年6月期间进行。
UNASSIGNED：四百名儿童因视盘肿胀而转诊。66例患者被证实患有视神经盘肿胀,344例患者出现假乳头水肿。平均年龄10.10±3.57岁,9.90±3.50岁,分别。视盘肿胀最常见的病因是特发性颅内高压（n=25）。视盘玻璃疣构成了假性视盘水肿的大部分（n=239），其余为拥挤/倾斜的视盘（n=105）。真正的视盘肿胀患者更容易出现头痛（OR=8.68，p<0.01）和视觉障碍（OR=2.14，p=0.03）。B扫描对视盘玻璃疣的检测最敏感（100％），其次是光学相干断层扫描（70.38％）和眼底自发荧光（44.86％）。与假乳头水肿相比，真实视盘肿胀的视网膜神经纤维层厚度明显更厚（p<0.01）。22例（33.33％）真实的视盘肿胀患者和33例（9.59％）假乳头水肿患者在眼科检查之前接受了神经影像学检查。
未经证实：儿童疑似视神经盘肿胀很可能是假性示波水肿。转诊应包括神经系统评估，视敏度,眼底摄影,和光学相干断层扫描，以协助眼科检查的分诊。对于没有神经系统症状的儿童，应不鼓励在眼科检查之前进行神经影像学检查。
