- Aaron Enten
- Julia Michalow
- Ashley Polhemus
- Brock Webberman
- Michael Boland, MD, PhD
- William Anderson, MD, PhD
- Deborah Stein, MD, MPH
- Wendy Ziai, MD
- Betsy Zink, MS, RN
Headaches in the Emergency Department
Each year, six million patients visit emergency departments (ED) in the United States (US) with headache as their primary complaint. While many of these patients are seeking treatment for intolerable, recurrent headaches such as migraines, up to 15percent of patients suffer from serious neurological conditions with emergent underlying pathologies. These high risk conditions are not easily discernable from benign headaches and can be fatal, requiring urgent diagnosis and treatment. However, neurological crises are misdiagnosed as migraines in up to 25percent of cases, resulting in wrongful discharge from the hospital, worse outcomes, and a higher chance of mortality.
Elevated intracranial pressure (ICP) is not only a symptom of many of these conditions, but also an independent point of concern, and treatment to reduce ICP is vital for preventing permanent brain damage. Some of the first observable symptoms of raised ICP occur in the eye. However, high intra and inter-observer variability during ophthalmic examinations have been reported of physicians in the emergency room and this prevents these tests from being used at the point of care.
InSpect: A Physician’s Aid for Timely Diagnosis
The inSpect system takes the skill of the ophthalmologist and places it in the hands of the emergency care provider. The inSpect digital ophthalmoscope collects video of the eye and uses processing software to automatically measure several key ophthalmic parameters on the pupil and the back of the eye. These parameters include abnormal pupillary response to light, papilledema, venous engorgement, and spontaneous venous pulsations. Our software leverages masking techniques used to detect and isolate the vasculature, with blob detection algorithms used to measure and track both the pupil and the optic disk. Videos are stabilized mechanically with a disposable eyepiece, as well as using digital rendering and point feature mapping. Our current eyepiece prototypes have been shown to reduce video instability due to hand movements during examinations by up to 90 percent.
Videos are analyzed to provide a real-time assessment of intracranial pressure, which is indicative of neurological crisis. Care providers can thus integrate this ophthalmic assessment with the physical examination for more accurate and timely differentiation between high and low risk headaches. Patients will benefit from faster administration of therapy and more reliable therapeutic decision-making to achieve optimal outcomes.