Objectives

Acute strabismus (AS) is the most common ocular motility disorder in children. In the emergency setting evaluation, the primary concern is to exclude a potentially dangerous underlying condition, requiring immediate intervention. Our first aim was to describe the epidemiology, clinical features, and underlying causes of AS in a cohort of children presenting to the emergency department (ED). Our second aim was to identify clinical features associated with a significant risk of underlying neurological emergencies (NEs).

Design and setting

Clinical records of all patients under 18 years presenting for AS to the ED of the Bambino Gesù Children's Hospital over a 10-year period were retrospectively reviewed. A logistic regression model was applied to detect predictive variables associated with a higher risk of NEs.

Results

208 patients (M:F = 1.19) were identified (0.35 cases per 1000 admission). Commonly associated symptoms included diplopia (18.3%), headache (23.1%), nausea or vomit (8.6%). Other ocular or neurological abnormalities were associated in 47.6% of patients. NEs accounted for 24.03% of all cases, mostly represented by brain tumours (8.65%). Ptosis, optic disk blurring, vomit, gait abnormalities and consciousness disorders were found to confer a significantly greater risk of an underlying NE.

Conclusions

Potentially severe neurological conditions may affect almost one in four children presenting to the ED for AS. Brain malignancies are the most common dangerous cause. Presence of ptosis, papilledema, vomit, gait disorders, consciousness impairment, pupillary defects and multiple cranial nerves involvement should be considered as red flags.

中文翻译：

---

儿童神经系统紧急情况中的急性斜视：一项回顾性单中心研究

目标

急性斜视（AS）是儿童中最常见的眼部运动障碍。在紧急情况评估中，首要考虑是排除潜在的潜在危险情况，需要立即进行干预。我们的首要目标是描述就诊于急诊室（ED）的一群儿童中AS的流行病学，临床特征和潜在原因。我们的第二个目标是确定与潜在的神经系统紧急情况（NEs）的重大风险相关的临床特征。

设计与设定

回顾性分析了10年内BambinoGesù儿童医院急诊就诊为AS的所有18岁以下患者的临床记录。应用逻辑回归模型检测与较高的NEs风险相关的预测变量。

结果

确定了208名患者（M：F = 1.19）（每1000例入院0.35例）。常见的症状包括复视（18.3％），头痛（23.1％），恶心或呕吐（8.6％）。47.6％的患者与其他眼部或神经系统异常有关。NE占所有病例的24.03％，主要表现为脑肿瘤（8.65％）。发现眼睑下垂，视盘模糊，呕吐，步态异常和意识障碍明显增加了潜在的NE风险。

结论

潜在的严重神经系统疾病可能会影响到急诊科就诊的AS患儿中几乎有四分之一。脑恶性肿瘤是最常见的危险原因。上睑下垂，乳头水肿，呕吐，步态障碍，意识障碍，瞳孔缺损和多发颅神经受累均应视为危险信号。