Patient headache questionnaires can improve headache diagnosis and treatment in children.
Patient headache questionnaires can improve headache diagnosis and treatment in children.
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患者头痛问卷可以改善儿童头痛的诊断和治疗。
作者：
Szperka,ChristinaL;Witzman,Stephanie;Ostapenko,Svetlana;Farrar,JohnT;Hsu,JesseYenchih;Malavolta,CarrieP;Bunney,JanilleD;Bange,ErinM;PattersonGentile,Carlyn;Velasquez,Gerardo;MarquezdePrado,Blanca;Cosico,Mahgenn;Lee,Meyeon
目的研究儿童神经病学队列中头痛和偏头痛的诊断趋势，并检验结合电子健康记录(EHR)的头痛调查问卷是否可以提高诊断的特异性和开出偏头痛治疗处方的可能性。当我们在2013年建立我们的儿童头痛项目时，我们意识到头痛患者被诊断为偏头痛的比例远远低于预期。方法我们开发了一份患者头痛问卷，最初是纸质的(2013-2014)，然后是电子数据库(2014-2016)，最后整合到我们的电子健康记录(试点：2016，完整：2017年5月)。我们比较了被诊断为头痛的新患者的诊断和处方治疗，观察了获得特定诊断(偏头痛等)的患者比例的趋势。而非特定的诊断则是“头痛”。接下来，我们进行了一项前瞻性队列研究，以测试提供者使用该表格与存在特定诊断之间的关联，然后测试特定诊断与偏头痛治疗处方之间的关联。结果在2011年7月至2022年12月期间，被诊断为偏头痛的新头痛患者比例上升了9.7%，非特定头痛诊断下降了21.0%。在电子病历队列(2017年6月至2022年12月，n= 15,122)中，使用提供者表格将特定诊断率提高到87.2%(1839/2109)，而不使用患者问卷的特定诊断率为75.5%(5708/7560)，做出特定诊断的几率几乎翻了一番(优势比[OR]1.90，95%可信区间[CI]：1.65-2.19)。与那些只接受非特异性头痛诊断的患者相比，53.7%(1766/3286)的患者接受了偏头痛治疗，75.3%(8914/11836)的患者接受了偏头痛治疗，这是开处方的几率的两倍多(OR 2.39，95%CI：2.20~2.60)。这些结果已经持续了几年。这份头痛的问卷被改编成EpicCare的基础系统，因此它作为使用该EHR软件的机构的临床和研究工具被广泛使用。
ObjectiveTo examine trends in diagnosis of headache and migraine in a large pediatric neurology cohort, and test whether an electronic health record (EHR)‐integrated headache questionnaire can increase specificity of diagnosis and likelihood of prescribing migraine treatment.BackgroundUnder‐diagnosis of migraine contributes to the burden of disease. As we founded our Pediatric Headache Program in 2013, we recognized that the proportion of patients with headache who were given a diagnosis of migraine was much lower than expected.MethodsWe developed a patient headache questionnaire, initially on paper (2013–2014), then in an electronic database (2014–2016), and finally integrated into our electronic health record (pilot: 2016, full: May 2017). We compared diagnoses and prescribed treatments for new patients who were given a headache diagnosis, looking at trends in the proportion of patients given specific diagnoses (migraine, etc.) versus the non‐specific diagnosis, “headache.” Next, we conducted a prospective cohort study to test for association between provider use of the form and the presence of a specific diagnosis, then for an association between specific diagnosis and prescription of migraine treatment.ResultsBetween July 2011 and December 2022 the proportion of new headache patients who were given a diagnosis of migraine increased 9.7% and non‐specific headache diagnoses decreased 21.0%. In the EHR cohort (June 2017–December 2022,n= 15,122), use of the provider form increased the rate of specific diagnosis to 87.2% (1839/2109) compared to 75.5% (5708/7560) without a patient questionnaire, nearly doubling the odds of making a specific diagnosis (odds ratio [OR] 1.90, 95% confidence interval [CI]: 1.65–2.19). Compared to those given only a non‐specific headache diagnosis who were prescribed a migraine therapy 53.7% (1766/3286) of the time, 75.3% (8914/11836) of those given a specific diagnosis received a migraine therapy, more than doubling the odds of prescription (OR 2.39, 95% CI: 2.20–2.60).ConclusionsInterventions to improve specificity of diagnosis were effective and led to increased rates of prescription of migraine treatments. These results have been sustained over several years. This headache questionnaire was adapted into the Foundation system of EpicCare, so it is broadly available as a clinical and research tool for institutions that use this EHR software.