Head Computed tomography during emergency department treat-and-release visit for headache is associated with increased risk of subsequent cerebrovascular disease hospitalization
Head Computed tomography during emergency department treat-and-release visit for headache is associated with increased risk of subsequent cerebrovascular disease hospitalization
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DOI：
10.1515/dx-2020-0082
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发表时间：
2021-01-01
期刊：
影响因子：
3.5
通讯作者：
Lipton, Richard B.
中科院分区：
文献类型：
--
作者：
Liberman, Ava L.;Wang, Cuiling;Lipton, Richard B.
目的：在急诊科（艾德）就诊时因非特异性神经系统症状进行头部计算机断层扫描（HCT）与随后卒中风险增加相关，可能是诊断错误的标志。我们评估HCT发生在艾德头痛患者是否与随后脑血管疾病的风险增加有关。方法：我们进行了一项回顾性队列研究，在一个多中心机构，对从艾德（艾德治疗和释放访视）出院回家的连续成人头痛患者进行了研究。头痛患者定义为2013年9月1日至2018年9月1日期间主要ICD-9/10-CM出院诊断代码为良性头痛的患者。使用ICD-9/10-CM代码确定脑血管疾病住院的主要结局，并通过病历审查确认。我们匹配的头痛患者谁有HCT（暴露），那些谁没有HCT（未暴露）在艾德在一对一的时尚使用倾向score methods.Results：在28,121成人患者艾德治疗和释放头痛访问，45.6%（n=12,811）进行HCT。共有0.4%（n=111）在索引访视的365天内发生脑血管住院。使用倾向评分匹配，80.4%（n= 10，296）的暴露患者与未暴露患者匹配。暴露患者在365天时脑血管住院的风险增加（RR：1.65：95% CI：1.18-2.31）和180天（RR：1.62; 95%CI：1.06-2.49）; 90或30天时脑血管住院的风险未增加。在艾德头痛治疗和缓解访视时进行HCT与后续脑血管疾病风险增加相关。未来的工作，以改善脑血管疾病的预防策略，在这一子集的头痛患者是必要的。
Objectives: The occurrence of head computed tomography (HCT) at emergency department (ED) visit for non-specific neurological symptoms has been associated with increased subsequent stroke risk and may be a marker of diagnostic error. We evaluate whether HCT occurrence among ED headache patients is associated with increased subsequent cerebrovascular disease risk.Methods: We conducted a retrospective cohort study of consecutive adult patients with headache who were discharged home from the ED (ED treat-and-release visit) at one multicenter institution. Patients with headache were defined as those with primary ICD-9/10-CM discharge diagnoses codes for benign headache from 9/1/2013-9/1/2018. The primary outcome of cerebrovascular disease hospitalization was identified using ICD-9/10-CM codes and confirmed via chart review. We matched headache patients who had a HCT (exposed) to those who did not have a HCT (unexposed) in the ED in a one-to-one fashion using propensity score methods.Results: Among the 28,121 adult patients with ED treat-and-release headache visit, 45.6% (n=12,811) underwent HCT. A total of 0.4% (n=111) had a cerebrovascular hospitalization within 365 days of index visit. Using propensity score matching, 80.4% (n=10,296) of exposed patients were matched to unexposed. Exposed patients had increased risk of cerebrovascular hospitalization at 365 days (RR: 1.65: 95% CI: 1.18-2.31) and 180 days (RR: 1.62; 95% CI: 1.06-2.49); risk of cerebrovascular hospitalization was not increased at 90 or 30 days.Conclusions: Having a HCT performed at ED treat-and-release headache visit is associated with increased risk of subsequent cerebrovascular disease. Future work to improve cerebrovascular disease prevention strategies in this subset of headache patients is warranted.