Acute diplopia in the pediatric Emergency Department. A cohort multicenter Italian study

U. Raucci, P. Parisi, N. Vanacore, F. La Penna, V. Ferro, L. Calistri, C. Bondone, F. Midulla, A. Suppiej, R. Falsaperla, D.M. Cordelli, A. Palmieri, A. Verrotti, S. Becciani, S. Aguzzi, M. Mastrangelo, F. Pelizza, F. Greco, G. Carbonari, R. TalloneG. Bottone, I. Trenta, S. Masi, M.P. Villa, A. Reale

Research output: Contribution to journalArticle

Abstract

Background Acute diplopia (AD) is an uncommon and distressing symptom of numerous ocular and neurological conditions, with potentially serious sequelaes. No data are present in pediatrics on the presentation and management of AD. Aim This study investigated characteristics, etiology and health care utilization of the pediatric population with AD accessed to pediatric Emergency Departments (ED), trying to identify “red flags” associated with potentially life-threatening (LT) conditions. Methods We conducted a cohort multicenter study on children with AD in ten Italian hospitals. Patients were classified into diagnostic categories, comparing children with and without LT disease. Results 621 children presented AD at a rate of 3.6 per 10.000. The most frequent diagnosis among no-LT conditions (81.2%) were headache, ocular disorders and minor post-traumatic disease, while LT conditions (18.8%) were represented by brain tumors, demyelinating conditions, idiopathic intracranial hypertension and major post-traumatic diseases. The LT group showed a significantly higher age, with the odds increased by 1% for each month of age. Monocular diplopia occurred in 16.1%, but unlike adult one-fifth presented LT conditions. Binocular diplopia, associated ocular manifestations or extraocular neurological signs were significantly more common in the LT group. At regression logistic analysis strabismus and ptosis were associated with LT conditions. Conclusion The majority of children presented no-LT conditions and more than one-fourth of patients had headache. Monocular diplopia in the LT group was never isolated but associated with other signs or symptoms. Our study was able to identify some specific ocular disturbances or neurologic signs potentially useful for ED physician to recognize patients with serious pathologies. © 2017 European Paediatric Neurology Society
Original languageEnglish
Pages (from-to)722-729
Number of pages8
JournalEuropean Journal of Paediatric Neurology
Volume21
Issue number5
DOIs
Publication statusPublished - 2017

Fingerprint

Diplopia
Multicenter Studies
Hospital Emergency Service
Pediatrics
Eye Manifestations
Patient Acceptance of Health Care
Pseudotumor Cerebri
Headache Disorders
Strabismus
Neurology
Neurologic Manifestations
Brain Neoplasms
Signs and Symptoms
Headache
Cohort Studies
Regression Analysis
Pathology
Physicians

Keywords

  • Child
  • Diplopia
  • Double vision
  • Emergency
  • Life threatening condition
  • Neuroimaging
  • acute disease
  • Article
  • child
  • clinical feature
  • cohort analysis
  • computer assisted tomography
  • consultation
  • controlled study
  • diplopia
  • emergency health service
  • eye disease
  • female
  • human
  • length of stay
  • major clinical study
  • male
  • neuroimaging
  • neurologic disease
  • nuclear magnetic resonance imaging
  • priority journal
  • ptosis
  • retrospective study
  • school child
  • strabismus
  • visual disorder
  • vomiting
  • adolescent
  • age
  • clinical trial
  • hospital emergency service
  • hospitalization
  • Italy
  • multicenter study
  • preschool child
  • Acute Disease
  • Adolescent
  • Age Factors
  • Child, Preschool
  • Cohort Studies
  • Emergency Service, Hospital
  • Female
  • Hospitalization
  • Humans
  • Male

Cite this

Acute diplopia in the pediatric Emergency Department. A cohort multicenter Italian study. / Raucci, U.; Parisi, P.; Vanacore, N.; La Penna, F.; Ferro, V.; Calistri, L.; Bondone, C.; Midulla, F.; Suppiej, A.; Falsaperla, R.; Cordelli, D.M.; Palmieri, A.; Verrotti, A.; Becciani, S.; Aguzzi, S.; Mastrangelo, M.; Pelizza, F.; Greco, F.; Carbonari, G.; Tallone, R.; Bottone, G.; Trenta, I.; Masi, S.; Villa, M.P.; Reale, A.

In: European Journal of Paediatric Neurology, Vol. 21, No. 5, 2017, p. 722-729.

Research output: Contribution to journalArticle

Raucci, U, Parisi, P, Vanacore, N, La Penna, F, Ferro, V, Calistri, L, Bondone, C, Midulla, F, Suppiej, A, Falsaperla, R, Cordelli, DM, Palmieri, A, Verrotti, A, Becciani, S, Aguzzi, S, Mastrangelo, M, Pelizza, F, Greco, F, Carbonari, G, Tallone, R, Bottone, G, Trenta, I, Masi, S, Villa, MP & Reale, A 2017, 'Acute diplopia in the pediatric Emergency Department. A cohort multicenter Italian study', European Journal of Paediatric Neurology, vol. 21, no. 5, pp. 722-729. https://doi.org/10.1016/j.ejpn.2017.05.010
Raucci, U. ; Parisi, P. ; Vanacore, N. ; La Penna, F. ; Ferro, V. ; Calistri, L. ; Bondone, C. ; Midulla, F. ; Suppiej, A. ; Falsaperla, R. ; Cordelli, D.M. ; Palmieri, A. ; Verrotti, A. ; Becciani, S. ; Aguzzi, S. ; Mastrangelo, M. ; Pelizza, F. ; Greco, F. ; Carbonari, G. ; Tallone, R. ; Bottone, G. ; Trenta, I. ; Masi, S. ; Villa, M.P. ; Reale, A. / Acute diplopia in the pediatric Emergency Department. A cohort multicenter Italian study. In: European Journal of Paediatric Neurology. 2017 ; Vol. 21, No. 5. pp. 722-729.
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title = "Acute diplopia in the pediatric Emergency Department. A cohort multicenter Italian study",
abstract = "Background Acute diplopia (AD) is an uncommon and distressing symptom of numerous ocular and neurological conditions, with potentially serious sequelaes. No data are present in pediatrics on the presentation and management of AD. Aim This study investigated characteristics, etiology and health care utilization of the pediatric population with AD accessed to pediatric Emergency Departments (ED), trying to identify “red flags” associated with potentially life-threatening (LT) conditions. Methods We conducted a cohort multicenter study on children with AD in ten Italian hospitals. Patients were classified into diagnostic categories, comparing children with and without LT disease. Results 621 children presented AD at a rate of 3.6 per 10.000. The most frequent diagnosis among no-LT conditions (81.2{\%}) were headache, ocular disorders and minor post-traumatic disease, while LT conditions (18.8{\%}) were represented by brain tumors, demyelinating conditions, idiopathic intracranial hypertension and major post-traumatic diseases. The LT group showed a significantly higher age, with the odds increased by 1{\%} for each month of age. Monocular diplopia occurred in 16.1{\%}, but unlike adult one-fifth presented LT conditions. Binocular diplopia, associated ocular manifestations or extraocular neurological signs were significantly more common in the LT group. At regression logistic analysis strabismus and ptosis were associated with LT conditions. Conclusion The majority of children presented no-LT conditions and more than one-fourth of patients had headache. Monocular diplopia in the LT group was never isolated but associated with other signs or symptoms. Our study was able to identify some specific ocular disturbances or neurologic signs potentially useful for ED physician to recognize patients with serious pathologies. {\circledC} 2017 European Paediatric Neurology Society",
keywords = "Child, Diplopia, Double vision, Emergency, Life threatening condition, Neuroimaging, acute disease, Article, child, clinical feature, cohort analysis, computer assisted tomography, consultation, controlled study, diplopia, emergency health service, eye disease, female, human, length of stay, major clinical study, male, neuroimaging, neurologic disease, nuclear magnetic resonance imaging, priority journal, ptosis, retrospective study, school child, strabismus, visual disorder, vomiting, adolescent, age, clinical trial, hospital emergency service, hospitalization, Italy, multicenter study, preschool child, Acute Disease, Adolescent, Age Factors, Child, Preschool, Cohort Studies, Emergency Service, Hospital, Female, Hospitalization, Humans, Male",
author = "U. Raucci and P. Parisi and N. Vanacore and {La Penna}, F. and V. Ferro and L. Calistri and C. Bondone and F. Midulla and A. Suppiej and R. Falsaperla and D.M. Cordelli and A. Palmieri and A. Verrotti and S. Becciani and S. Aguzzi and M. Mastrangelo and F. Pelizza and F. Greco and G. Carbonari and R. Tallone and G. Bottone and I. Trenta and S. Masi and M.P. Villa and A. Reale",
note = "Export Date: 11 April 2018 CODEN: EJPNF Correspondence Address: Raucci, U.; Pediatric Emergency Department, Bambino Ges{\`u} Children's Hospital, IRCCSItaly; email: umberto.raucci@opbg.net References: Richardson, L.D., Joyce, D.M., Diplopia in emergency department (1997) Emerg Med Clin North Am, 15, pp. 649-664; Nazerian, P., Vanni, S., Tarocchi, C., Causes of diplopia in the emergency department: diagnostic accuracy of clinical assessment and of head computed tomography (2014) Eur J Emerg Med, 2, pp. 118-124; Alves, M., Miranda, A., Narciso, M.R., Mieiro, L., Fonseca, T., Diplopia: a diagnostic challenge with common and rare etiologies (2015) Am J Case Rep, 16, pp. 220-223; Friedmann, D.I., Pearls: diplopia (2010) Semin Neurol, 30, pp. 54-65; O'Colmain, U., Gilmour, C., MacEwen, C.J., Acute-onset diplopia (2014) Acta Ophtalmol, 92, pp. 382-386; Boutis, K., Cogollo, W., Fisher, J., Parental knowledge of potential cancer risk from exposure to computed tomography (2013) Pediatrics, 132, pp. 305-311; Miglioretti, D.L., Johnson, E., Williams, A., The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk (2013) JAMA Pediatr, 167, pp. 700-707; Berrington de Gonzalez, A., Salotti, J.A., McHugh, K., Relationship between paediatric CT scans and subsequent risk of leukaemia and brain tumours: assessment of the impact of underlying conditions (2016) Br J Cancer, 114, pp. 388-394; Morris, R.J., Double vision as a presenting symptom in an ophthalmic casualty department (1991) Eye, 5, pp. 124-129; Comer, R.M., Dawson, E., Plant, G., Acheson, J.F., Lee, J.P., Causes and outcomes for patients presenting with diplopia to an eye casualty department (2007) Eye, 21, pp. 413-418; Uscher-Pines, L., Pines, J., Kellermann, A., Gillen, E., Mehrotra, A., Emergency department visits for nonurgent conditions: systematic literature review (2013) Am J Manag Care, 19, pp. 47-59; Amos, J.F., Diagnosis and management of monocular diplopia (1986) J Am Ophtalmol Assoc, 53, pp. 101-115; Osorio, M.J., Zuckerbraun, N.S., Painter, M., Acute pupil asymmetry in a 6-month-old boy. Diagnosis: pharmacologic anisocoria (2009) Pediatr Ann, 38, pp. 622-624; Lyons, C.J., Godoy, F., ALQahtani, E., Cranial nerve palsies in childhood (2015) Eye, 29, pp. 246-251; Raucci, U., Vanacore, N., Paolino, M.C., Vertigo/dizziness in pediatric emergency department: five years' experience (2016) Cephalalgia, 36, pp. 593-598; Broder, J., Fordham, L.A., Warshauer, D.M., Increasing utilization of computed tomography in the pediatric emergency department, 2000–2006 (2007) Emerg Radiol, 14, pp. 227-232; Larson, D.B., Johnson, L.W., Schnell, B.N., Rising use of CT in child visits to emergency department in the United States, 1995–2008 (2011) Radiology, 259, pp. 793-801; Korley, F.K., Pham, J.C., Kirsch, T.D., Use of advanced radiology during visits to US emergency departments for injury-related conditions, 1998–2007 (2010) JAMA, 304, pp. 1465-1471",
year = "2017",
doi = "10.1016/j.ejpn.2017.05.010",
language = "English",
volume = "21",
pages = "722--729",
journal = "European Journal of Paediatric Neurology",
issn = "1090-3798",
publisher = "W.B. Saunders Ltd",
number = "5",

}

TY - JOUR

T1 - Acute diplopia in the pediatric Emergency Department. A cohort multicenter Italian study

AU - Raucci, U.

AU - Parisi, P.

AU - Vanacore, N.

AU - La Penna, F.

AU - Ferro, V.

AU - Calistri, L.

AU - Bondone, C.

AU - Midulla, F.

AU - Suppiej, A.

AU - Falsaperla, R.

AU - Cordelli, D.M.

AU - Palmieri, A.

AU - Verrotti, A.

AU - Becciani, S.

AU - Aguzzi, S.

AU - Mastrangelo, M.

AU - Pelizza, F.

AU - Greco, F.

AU - Carbonari, G.

AU - Tallone, R.

AU - Bottone, G.

AU - Trenta, I.

AU - Masi, S.

AU - Villa, M.P.

AU - Reale, A.

N1 - Export Date: 11 April 2018 CODEN: EJPNF Correspondence Address: Raucci, U.; Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCSItaly; email: umberto.raucci@opbg.net References: Richardson, L.D., Joyce, D.M., Diplopia in emergency department (1997) Emerg Med Clin North Am, 15, pp. 649-664; Nazerian, P., Vanni, S., Tarocchi, C., Causes of diplopia in the emergency department: diagnostic accuracy of clinical assessment and of head computed tomography (2014) Eur J Emerg Med, 2, pp. 118-124; Alves, M., Miranda, A., Narciso, M.R., Mieiro, L., Fonseca, T., Diplopia: a diagnostic challenge with common and rare etiologies (2015) Am J Case Rep, 16, pp. 220-223; Friedmann, D.I., Pearls: diplopia (2010) Semin Neurol, 30, pp. 54-65; O'Colmain, U., Gilmour, C., MacEwen, C.J., Acute-onset diplopia (2014) Acta Ophtalmol, 92, pp. 382-386; Boutis, K., Cogollo, W., Fisher, J., Parental knowledge of potential cancer risk from exposure to computed tomography (2013) Pediatrics, 132, pp. 305-311; Miglioretti, D.L., Johnson, E., Williams, A., The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk (2013) JAMA Pediatr, 167, pp. 700-707; Berrington de Gonzalez, A., Salotti, J.A., McHugh, K., Relationship between paediatric CT scans and subsequent risk of leukaemia and brain tumours: assessment of the impact of underlying conditions (2016) Br J Cancer, 114, pp. 388-394; Morris, R.J., Double vision as a presenting symptom in an ophthalmic casualty department (1991) Eye, 5, pp. 124-129; Comer, R.M., Dawson, E., Plant, G., Acheson, J.F., Lee, J.P., Causes and outcomes for patients presenting with diplopia to an eye casualty department (2007) Eye, 21, pp. 413-418; Uscher-Pines, L., Pines, J., Kellermann, A., Gillen, E., Mehrotra, A., Emergency department visits for nonurgent conditions: systematic literature review (2013) Am J Manag Care, 19, pp. 47-59; Amos, J.F., Diagnosis and management of monocular diplopia (1986) J Am Ophtalmol Assoc, 53, pp. 101-115; Osorio, M.J., Zuckerbraun, N.S., Painter, M., Acute pupil asymmetry in a 6-month-old boy. Diagnosis: pharmacologic anisocoria (2009) Pediatr Ann, 38, pp. 622-624; Lyons, C.J., Godoy, F., ALQahtani, E., Cranial nerve palsies in childhood (2015) Eye, 29, pp. 246-251; Raucci, U., Vanacore, N., Paolino, M.C., Vertigo/dizziness in pediatric emergency department: five years' experience (2016) Cephalalgia, 36, pp. 593-598; Broder, J., Fordham, L.A., Warshauer, D.M., Increasing utilization of computed tomography in the pediatric emergency department, 2000–2006 (2007) Emerg Radiol, 14, pp. 227-232; Larson, D.B., Johnson, L.W., Schnell, B.N., Rising use of CT in child visits to emergency department in the United States, 1995–2008 (2011) Radiology, 259, pp. 793-801; Korley, F.K., Pham, J.C., Kirsch, T.D., Use of advanced radiology during visits to US emergency departments for injury-related conditions, 1998–2007 (2010) JAMA, 304, pp. 1465-1471

PY - 2017

Y1 - 2017

N2 - Background Acute diplopia (AD) is an uncommon and distressing symptom of numerous ocular and neurological conditions, with potentially serious sequelaes. No data are present in pediatrics on the presentation and management of AD. Aim This study investigated characteristics, etiology and health care utilization of the pediatric population with AD accessed to pediatric Emergency Departments (ED), trying to identify “red flags” associated with potentially life-threatening (LT) conditions. Methods We conducted a cohort multicenter study on children with AD in ten Italian hospitals. Patients were classified into diagnostic categories, comparing children with and without LT disease. Results 621 children presented AD at a rate of 3.6 per 10.000. The most frequent diagnosis among no-LT conditions (81.2%) were headache, ocular disorders and minor post-traumatic disease, while LT conditions (18.8%) were represented by brain tumors, demyelinating conditions, idiopathic intracranial hypertension and major post-traumatic diseases. The LT group showed a significantly higher age, with the odds increased by 1% for each month of age. Monocular diplopia occurred in 16.1%, but unlike adult one-fifth presented LT conditions. Binocular diplopia, associated ocular manifestations or extraocular neurological signs were significantly more common in the LT group. At regression logistic analysis strabismus and ptosis were associated with LT conditions. Conclusion The majority of children presented no-LT conditions and more than one-fourth of patients had headache. Monocular diplopia in the LT group was never isolated but associated with other signs or symptoms. Our study was able to identify some specific ocular disturbances or neurologic signs potentially useful for ED physician to recognize patients with serious pathologies. © 2017 European Paediatric Neurology Society

AB - Background Acute diplopia (AD) is an uncommon and distressing symptom of numerous ocular and neurological conditions, with potentially serious sequelaes. No data are present in pediatrics on the presentation and management of AD. Aim This study investigated characteristics, etiology and health care utilization of the pediatric population with AD accessed to pediatric Emergency Departments (ED), trying to identify “red flags” associated with potentially life-threatening (LT) conditions. Methods We conducted a cohort multicenter study on children with AD in ten Italian hospitals. Patients were classified into diagnostic categories, comparing children with and without LT disease. Results 621 children presented AD at a rate of 3.6 per 10.000. The most frequent diagnosis among no-LT conditions (81.2%) were headache, ocular disorders and minor post-traumatic disease, while LT conditions (18.8%) were represented by brain tumors, demyelinating conditions, idiopathic intracranial hypertension and major post-traumatic diseases. The LT group showed a significantly higher age, with the odds increased by 1% for each month of age. Monocular diplopia occurred in 16.1%, but unlike adult one-fifth presented LT conditions. Binocular diplopia, associated ocular manifestations or extraocular neurological signs were significantly more common in the LT group. At regression logistic analysis strabismus and ptosis were associated with LT conditions. Conclusion The majority of children presented no-LT conditions and more than one-fourth of patients had headache. Monocular diplopia in the LT group was never isolated but associated with other signs or symptoms. Our study was able to identify some specific ocular disturbances or neurologic signs potentially useful for ED physician to recognize patients with serious pathologies. © 2017 European Paediatric Neurology Society

KW - Child

KW - Diplopia

KW - Double vision

KW - Emergency

KW - Life threatening condition

KW - Neuroimaging

KW - acute disease

KW - Article

KW - child

KW - clinical feature

KW - cohort analysis

KW - computer assisted tomography

KW - consultation

KW - controlled study

KW - diplopia

KW - emergency health service

KW - eye disease

KW - female

KW - human

KW - length of stay

KW - major clinical study

KW - male

KW - neuroimaging

KW - neurologic disease

KW - nuclear magnetic resonance imaging

KW - priority journal

KW - ptosis

KW - retrospective study

KW - school child

KW - strabismus

KW - visual disorder

KW - vomiting

KW - adolescent

KW - age

KW - clinical trial

KW - hospital emergency service

KW - hospitalization

KW - Italy

KW - multicenter study

KW - preschool child

KW - Acute Disease

KW - Adolescent

KW - Age Factors

KW - Child, Preschool

KW - Cohort Studies

KW - Emergency Service, Hospital

KW - Female

KW - Hospitalization

KW - Humans

KW - Male

U2 - 10.1016/j.ejpn.2017.05.010

DO - 10.1016/j.ejpn.2017.05.010

M3 - Article

VL - 21

SP - 722

EP - 729

JO - European Journal of Paediatric Neurology

JF - European Journal of Paediatric Neurology

SN - 1090-3798

IS - 5

ER -