Headache etiology in a pediatric emergency department
Headache etiology in a pediatric emergency department
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DOI：
10.1097/00006565-199702000-00001
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发表时间：
1997-02-01
影响因子：
1.4
通讯作者：
Pourani, M
中科院分区：
文献类型：
--
作者：
Burton, LJ;Quinn, B;Pourani, M
背景：头痛可能是严重诊断的主诉，如脑膜炎、脑肿瘤或分流器功能障碍，但以前没有研究检查以头痛为主诉的儿科急诊科（ED）人群的诊断谱。方法：1993年对某城市儿童医院急诊科就诊53988人次。696名患者（1.3%）以头痛为主诉。在这些全年随机分配的访问中，有一半被选中进行审查；总样本量为288。结果：患者年龄2 ~ 18岁（2 ~ 5岁，24.3%；6 ~ 12岁，57.6%；13 ~ 18岁，18.1%）。ED的诊断包括病毒性疾病（39.2%）、鼻窦炎（16.0%）、偏头痛（15.6%）、创伤后头痛（6.6%）、链球菌性咽炎（4.9%）和紧张性头痛（4.5%）。在急诊科就诊时未发现脑肿瘤或细菌性脑膜炎病例。诊断出的严重神经系统疾病有病毒性脑膜炎15例（5.2%），分流器功能障碍1例，新诊断的脑积水1例，Burkitt淋巴瘤合并新诊断的中枢神经系统浸润1例，头部外伤后点状出血1例。三分之二的患者进行了放射学和/或实验室检查。鼻窦x线片阳性率为45.6%，快速链球菌抗原检查阳性率为16.3%，腰椎穿刺阳性率为60.9%，脑影像学检查阳性率为19.0%。将严重和非严重疾病引起头痛的频率与普通急诊科的数据进行比较。结论：小儿急诊科以头痛为主诉的严重疾病在我国人群中并不常见。在我们的综述中，最常见的诊断是病毒性疾病、鼻窦炎和偏头痛，而在成人研究中，紧张性头痛和偏头痛最常见。只有6.6%的患者有严重的神经系统疾病诊断，这与普通急诊科报告的范围一致。在我们研究的严重情况中，80%是病毒性脑膜炎。
Background: Headache may be the presenting complaint of serious diagnoses such as meningitis, brain tumor, or shunt malfunction, yet no previous studies have examined the spectrum of diagnoses for the pediatric emergency department (ED) population with a chief complaint of headache.Methods: In 1993, 53,988 visits were made to the ED of an urban children's hospital. Six hundred ninety-six patients (1.3%) had a chief complaint of headache. Half of these visits, distributed randomly throughout the year, were chosen for review; total sample size was 288.Results: Patient age ranged from two to 18 years (2-5 years, 24.3%; 6-12 years, 57.6%; 13-18 years, 18.1%). The spectrum of ED diagnoses included viral illness (39.2%), sinusitis (16.0%), migraine (15.6%), post-traumatic headache (6.6%), streptococcal pharyngitis (4.9%), and tension headache (4.5%). No cases of brain tumor or bacterial meningitis were identified at the time of ED visit. The only serious neurologic conditions diagnosed were 15 cases of viral meningitis (5.2%), one shunt malfunction, one newly diagnosed hydrocephalus, one Burkitt's lymphoma patient with newly diagnosed CNS infiltration, and one punctate hemorrhage post head trauma. Two thirds of patients had radiologic and/or laboratory tests. Positive findings were as follows: 45.6% of sinus radiographs, 16.3% of rapid streptococcal antigen tests, 60.9% of lumbar punctures, and 19.0% of brain imaging studies. The frequency of serious and nonserious conditions as a cause of headache was compared to data from general EDs.Conclusion: Serious conditions presenting with the chief complaint of headache in the pediatric ED were not common in our population. The most frequent diagnoses in our review were viral illness, sinusitis, and migraine, in contrast to adult studies in which tension headache and migraine were most common. Only 6.6% of patients had serious neurologic diagnoses, which is in the range reported for general EDs. Of the Serious conditions in our study, 80% were viral meningitis.