The utility of clinical features in patients presenting with nontraumatic headache: An investigation of adult patients attending an emergency department
The utility of clinical features in patients presenting with nontraumatic headache: An investigation of adult patients attending an emergency department
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DOI：
10.1111/j.1526-4610.2006.00448.x
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发表时间：
2006-06-01
期刊：
影响因子：
5
通讯作者：
Mason, Suzanne M.
中科院分区：
文献类型：
--
作者：
Locker, Thomas E.;Thompson, Catriona;Mason, Suzanne M.
目的：当患者因非创伤性头痛而到急诊科就诊时，他们通常会提出诊断挑战。本研究的目的是探讨实用程序的临床特征，在检测严重的潜在原因，非创伤性头痛的成人患者提出到急诊科。方法：一个前瞻性的观察性研究，警惕成人患者提出1英国急诊科超过14个月的时间进行。如果患者的头痛与创伤有关，或者他们以前被招募到研究中，则被排除在外。使用标准化数据收集表记录病史和检查结果的详细信息。调查和管理是根据现有的部门规程进行的。患者在初次就诊后随访3个月。每个因素的历史和考试进行了检查，其能力来预测一个严重的根本原因headach.Results：五百八十九例患者被列入研究，获得完整的后续细节558（94.7%）例。75例（13.4%）患者被发现有一个严重的病理原因，他们的头痛。发现四个特征是严重病理学的显著独立预测因子，这些特征是年龄> 50岁（似然比（LR）= 2.34）、突然发作（LR = 1.74）、神经学检查的任何异常（LR = 3.56）和由于相关特征引起的表现（LR = 2.27）。综合考虑，前3个特征中的任何一个的存在具有98.6%的灵敏度和34.4%的特异性（正LR = 1.50，负LR = 0.04）。结论：年龄超过50岁、突然发病和神经系统检查异常这三个特征被确定为严重病理学的重要独立预测因素，综合起来，可以排除这种病理在表现为非创伤性头痛的成年患者中的存在。
Objective: When patients present to an emergency department because of nontraumatic headache, they often present a diagnostic challenge. This study aimed to examine the utility of clinical features in detecting serious underlying causes of nontraumatic headache in adult patients presenting to an emergency department.Methods: A prospective observational study of alert adult patients presenting to 1 UK emergency department over a period of 14 months was conducted. Patients were excluded if their headache was related to trauma or they had been previously recruited into the study. A standardized data collection form was used to record details of the history and examination findings. Investigation and management were conducted according to the existing departmental protocols. Patients were followed up for 3 months following their initial presentation. Each factor in the history and examination was examined for its ability to predict a serious underlying cause of headache.Results: Five hundred and eighty-nine patients were included in the study with complete follow-up details obtained on 558 (94.7%) patients. Seventy-five (13.4%) patients were found to have a serious pathological cause of their headache. Four features were found to be significant independent predictors of serious pathology, these were age > 50 years (likelihood ratio (LR) = 2.34), sudden onset, (LR = 1.74), any abnormality on neurological examination (LR = 3.56), and presentation due to associated features (LR = 2.27). Taken in combination, the presence of any 1 of the first 3 features has a sensitivity of 98.6% and specificity of 34.4% (Positive LR = 1.50, Negative LR = 0.04).Conclusion: Three features, age greater than 50, sudden onset, and an abnormal neurological examination, are identified as significant independent predictors of serious pathology, which, in combination, can exclude the presence of such pathology in adult patients presenting with nontraumatic headache.