A cohort study on acute ocular motility disorders in pediatric emergency department

Umberto Raucci, Pasquale Parisi, Nicola Vanacore, Valentina Ferro, Giacomo Garone, Federica Sancetta, Sergio Petroni, Stefano Pro, Rossella Rossi, Antonino Reale, Nicola Pirozzi

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Acute ocular motility disorders (OMDs) in children admitted to Emergency Department (ED) represents a not so rare condition with a wide spectrum of different etiologies. The emergency physician must be skilled in rapidly identifying patients with potentially life threatening (LT) forms, requiring further diagnostic procedures. The aim of the study was to assess characteristics of children with acute Ocular Motility Disorders (OMDs), and to identify "red flags" for recognition of underlying life-threatening (LT) conditions.METHODS: A retrospective cohort study evaluated children (2 months-17 years) admitted to a tertiary Emergency Department in 2009-2014. A subgroup analysis was performed comparing children with and without LT conditions.RESULTS: Of 192 visits for OMDs, the isolated strabismus occurred most frequently (55.6%), followed by pupil disorders (31.8%), ptosis (5.2%) and combined OMDs (11.5%). The majority of acute OMDs involved no underlying LT conditions (n = 136) and most of them were infants or toddlers (50%). In a multivariable analysis, LT conditions included especially children over 6 years of age, increasing the odds ratio by 2% for each months of age (p = 0.009). LT etiologies were 16 times more likely in combined OMDs (p = 0.018), were over 13 times more likely to report associated extra-ocular signs/symptoms (p = 0.017) and over 50 times more likely to report co-morbidity (p = 0.017).CONCLUSION: OMDs are not an uncommon presentation at ED. Although most of them involve non-LT conditions, the ED physician should consider potential "red flags" for appropriate management of children such as age > 6 years, combined OMDs, extra-ocular symptoms and co-morbidity.
Original languageEnglish
JournalItalian Journal of Pediatrics
Volume44
Issue number1
DOIs
Publication statusPublished - May 29 2018

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Ocular Motility Disorders
Hospital Emergency Service
Cohort Studies
Pediatrics
Pupil Disorders
Morbidity
Physicians
Strabismus
Signs and Symptoms
Emergencies
Retrospective Studies
Odds Ratio

Keywords

  • Acute Disease
  • Adolescent
  • Age Distribution
  • Child
  • Child, Preschool
  • Cohort Studies
  • Emergency Service, Hospital
  • Female
  • Follow-Up Studies
  • Hospitalization/statistics & numerical data
  • Humans
  • Infant
  • Italy/epidemiology
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Ocular Motility Disorders/diagnosis
  • Prevalence
  • Retrospective Studies
  • Risk Assessment
  • Sex Distribution

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A cohort study on acute ocular motility disorders in pediatric emergency department. / Raucci, Umberto; Parisi, Pasquale; Vanacore, Nicola; Ferro, Valentina; Garone, Giacomo; Sancetta, Federica; Petroni, Sergio; Pro, Stefano; Rossi, Rossella; Reale, Antonino; Pirozzi, Nicola.

In: Italian Journal of Pediatrics, Vol. 44, No. 1, 29.05.2018.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Acute ocular motility disorders (OMDs) in children admitted to Emergency Department (ED) represents a not so rare condition with a wide spectrum of different etiologies. The emergency physician must be skilled in rapidly identifying patients with potentially life threatening (LT) forms, requiring further diagnostic procedures. The aim of the study was to assess characteristics of children with acute Ocular Motility Disorders (OMDs), and to identify {"}red flags{"} for recognition of underlying life-threatening (LT) conditions.METHODS: A retrospective cohort study evaluated children (2 months-17 years) admitted to a tertiary Emergency Department in 2009-2014. A subgroup analysis was performed comparing children with and without LT conditions.RESULTS: Of 192 visits for OMDs, the isolated strabismus occurred most frequently (55.6{\%}), followed by pupil disorders (31.8{\%}), ptosis (5.2{\%}) and combined OMDs (11.5{\%}). The majority of acute OMDs involved no underlying LT conditions (n = 136) and most of them were infants or toddlers (50{\%}). In a multivariable analysis, LT conditions included especially children over 6 years of age, increasing the odds ratio by 2{\%} for each months of age (p = 0.009). LT etiologies were 16 times more likely in combined OMDs (p = 0.018), were over 13 times more likely to report associated extra-ocular signs/symptoms (p = 0.017) and over 50 times more likely to report co-morbidity (p = 0.017).CONCLUSION: OMDs are not an uncommon presentation at ED. Although most of them involve non-LT conditions, the ED physician should consider potential {"}red flags{"} for appropriate management of children such as age > 6 years, combined OMDs, extra-ocular symptoms and co-morbidity.",
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author = "Umberto Raucci and Pasquale Parisi and Nicola Vanacore and Valentina Ferro and Giacomo Garone and Federica Sancetta and Sergio Petroni and Stefano Pro and Rossella Rossi and Antonino Reale and Nicola Pirozzi",
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T1 - A cohort study on acute ocular motility disorders in pediatric emergency department

AU - Raucci, Umberto

AU - Parisi, Pasquale

AU - Vanacore, Nicola

AU - Ferro, Valentina

AU - Garone, Giacomo

AU - Sancetta, Federica

AU - Petroni, Sergio

AU - Pro, Stefano

AU - Rossi, Rossella

AU - Reale, Antonino

AU - Pirozzi, Nicola

PY - 2018/5/29

Y1 - 2018/5/29

N2 - BACKGROUND: Acute ocular motility disorders (OMDs) in children admitted to Emergency Department (ED) represents a not so rare condition with a wide spectrum of different etiologies. The emergency physician must be skilled in rapidly identifying patients with potentially life threatening (LT) forms, requiring further diagnostic procedures. The aim of the study was to assess characteristics of children with acute Ocular Motility Disorders (OMDs), and to identify "red flags" for recognition of underlying life-threatening (LT) conditions.METHODS: A retrospective cohort study evaluated children (2 months-17 years) admitted to a tertiary Emergency Department in 2009-2014. A subgroup analysis was performed comparing children with and without LT conditions.RESULTS: Of 192 visits for OMDs, the isolated strabismus occurred most frequently (55.6%), followed by pupil disorders (31.8%), ptosis (5.2%) and combined OMDs (11.5%). The majority of acute OMDs involved no underlying LT conditions (n = 136) and most of them were infants or toddlers (50%). In a multivariable analysis, LT conditions included especially children over 6 years of age, increasing the odds ratio by 2% for each months of age (p = 0.009). LT etiologies were 16 times more likely in combined OMDs (p = 0.018), were over 13 times more likely to report associated extra-ocular signs/symptoms (p = 0.017) and over 50 times more likely to report co-morbidity (p = 0.017).CONCLUSION: OMDs are not an uncommon presentation at ED. Although most of them involve non-LT conditions, the ED physician should consider potential "red flags" for appropriate management of children such as age > 6 years, combined OMDs, extra-ocular symptoms and co-morbidity.

AB - BACKGROUND: Acute ocular motility disorders (OMDs) in children admitted to Emergency Department (ED) represents a not so rare condition with a wide spectrum of different etiologies. The emergency physician must be skilled in rapidly identifying patients with potentially life threatening (LT) forms, requiring further diagnostic procedures. The aim of the study was to assess characteristics of children with acute Ocular Motility Disorders (OMDs), and to identify "red flags" for recognition of underlying life-threatening (LT) conditions.METHODS: A retrospective cohort study evaluated children (2 months-17 years) admitted to a tertiary Emergency Department in 2009-2014. A subgroup analysis was performed comparing children with and without LT conditions.RESULTS: Of 192 visits for OMDs, the isolated strabismus occurred most frequently (55.6%), followed by pupil disorders (31.8%), ptosis (5.2%) and combined OMDs (11.5%). The majority of acute OMDs involved no underlying LT conditions (n = 136) and most of them were infants or toddlers (50%). In a multivariable analysis, LT conditions included especially children over 6 years of age, increasing the odds ratio by 2% for each months of age (p = 0.009). LT etiologies were 16 times more likely in combined OMDs (p = 0.018), were over 13 times more likely to report associated extra-ocular signs/symptoms (p = 0.017) and over 50 times more likely to report co-morbidity (p = 0.017).CONCLUSION: OMDs are not an uncommon presentation at ED. Although most of them involve non-LT conditions, the ED physician should consider potential "red flags" for appropriate management of children such as age > 6 years, combined OMDs, extra-ocular symptoms and co-morbidity.

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KW - Female

KW - Follow-Up Studies

KW - Hospitalization/statistics & numerical data

KW - Humans

KW - Infant

KW - Italy/epidemiology

KW - Logistic Models

KW - Male

KW - Multivariate Analysis

KW - Ocular Motility Disorders/diagnosis

KW - Prevalence

KW - Retrospective Studies

KW - Risk Assessment

KW - Sex Distribution

U2 - 10.1186/s13052-018-0502-0

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JO - Italian Journal of Pediatrics

JF - Italian Journal of Pediatrics

SN - 1720-8424

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