Central retinal artery occlusion - detection score

Maria Casagrande; Nils Alexander Steinhorst; Susanne Kathrin Dippel; Fabian Kück; Carsten Grohmann; Martin S Spitzer; Sven Poli; Nicolas Feltgen; Maximilian Schultheiss

doi:10.3389/fmed.2023.1129002

Central retinal artery occlusion - detection score

Front Med (Lausanne). 2023 Mar 1:10:1129002. doi: 10.3389/fmed.2023.1129002. eCollection 2023.

Authors

Maria Casagrande¹, Nils Alexander Steinhorst¹, Susanne Kathrin Dippel², Fabian Kück³, Carsten Grohmann¹, Martin S Spitzer¹, Sven Poli^{4

5}, Nicolas Feltgen², Maximilian Schultheiss¹

Affiliations

¹ Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
² Department of Ophthalmology, University Medical Center Göttingen, Göttingen, Germany.
³ Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.
⁴ Department of Neurology and Stroke, University of Tübingen, Tübingen, Germany.
⁵ Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.

Abstract

Purpose: To investigate the sensitivity and specificity of central retinal artery occlusion (CRAO)-Detection Score in diagnosing CRAO via questionnaire and without fundoscopy.

Methods: This prospective study enrolled 176 emergency patients suffering from acute visual loss, of whom 38 were suffering from CRAO. Before conducting any examination, we administered our questionnaire containing six questions, followed by a thorough ophthalmologic examination to make the diagnosis. Statistical analysis involved a LASSO penalised multivariate logistic regression model.

Results: Our receiver operating characteristic (ROC) analysis based on a LASSO penalised multivariate logistic regression model showed an area under the curve (AUC) of 0.9 - three out of six questions were selected by LASSO. Interestingly, the unweighted ROC analysis of only two questions (Short CRAO-Detection Score) yielded similar results with an AUC of 0.88. The short CRAO-Detection Score of 2 yielded 14% (4/28) false positive patients.

Conclusion: This prospective study demonstrates that a high percentage of CRAO patients are detectable with a questionnaire. The CRAO-Detection Score might be used to triage patients suffering acute visual loss, which is important as intravenous fibrinolysis seem to be time-dependent to be effective.

Keywords: CRAO; central retinal artery occlusion; questionnaire; stroke; triage.