Atraumatic headache in US emergency departments: recent trends in CT/MRI utilisation and factors associated with severe intracranial pathology
Emergency Medicine Journal, 08/25/2011
Gilbert JW et al. – The use of CT/MRI for evaluation of atraumatic headache increased dramatically in emergency departments (EDs) in the USA between 1998 and 2008. The prevalence of intracranial pathology (ICP) among patients who received CT/MRI declined concurrently, suggesting a role for clinical decision support to guide more judicious use of imaging.
Data were obtained from the USA National Hospital Ambulatory Medical Care Survey of emergency department (ED) visits between 1998 and 2008.
A cohort of atraumatic headache-related visits were identified using preassigned ‘reason-for-visit’ codes.
Sample visits were weighted to provide national estimates.
Between 1998 and 2008 the percentage of patients presenting to the ED with atraumatic headache who underwent imaging increased from 12.5% to 31.0% (p<0.01) while the prevalence of ICP among those visits decreased from 10.1% to 3.5% (p<0.05).
The length of stay in the ED was 4.6 h (95% CI 4.4 to 4.8) for patients with headache who received imaging compared with 2.7 (95% CI 2.6 to 2.9) for those who did not.
Of 18 factors evaluated in patients with headache, 10 were associated with a significantly increased odds of an ICP diagnosis: age ≥50 years, arrival by ambulance, triage immediacy <15 min, systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥100 mmHg and disturbance in sensation, vision, speech or motor function including neurological weakness.
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