The child with headache in a pediatric emergency department
The child with headache in a pediatric emergency department
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DOI：
10.1111/j.1526-4610.2007.01052.x
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发表时间：
2008-07-01
期刊：
影响因子：
5
通讯作者：
Valeriani, Massimiliano
中科院分区：
文献类型：
--
作者：
Conicella, Elena;Raucci, Umberto;Valeriani, Massimiliano
目标。目的：调查在儿科急诊科（ED）就诊的儿童头痛患者的临床特征，并鉴别出那些更可能与严重的、危及生命的疾病相关的头痛特征，以区别于由于良性过程引起的头痛。尽管头痛是儿科急诊科就诊儿童的常见问题，但迄今为止，一些研究试图确定最有可能与疑似危及生命的疾病相关的临床特征。-对1年内所有连续在急诊科以头痛为主诉的患者进行回顾性分析。病因按照国际头痛学会诊断标准第2版进行分类。- 432名年龄在2 - 18岁（平均8.9岁）的儿童（占总就诊人数的0.8%）被纳入我们的研究。男生228人（53%），女生204人（47%）。学龄群体是最具代表性的（66%）。头痛最常见的原因是上呼吸道感染（19.2%）。其余大多数非危及生命的头痛包括偏头痛（18.5%）、创伤后头痛（5.5%）、紧张性头痛（4.6%）。严重危及生命的颅内疾病（4.1%）包括脑膜炎（1.6%）、急性脑积水（0.9%）、肿瘤（0.7%）。我们发现了一些临床线索，这些线索显示了与危险情况的统计学意义上的相关性：学龄前年龄、近期疼痛发作、枕部位置、儿童无法描述疼痛的质量和客观神经体征。-原发性和继发性头痛的鉴别诊断非常困难，特别是在急诊科。大多数头痛是继发于呼吸道传染病和轻微的头部创伤。我们的数据使我们能够确定对识别颅内危及生命的疾病有用的临床特征。
Objectives.-To investigate clinical features of a pediatric population presenting with headache to a pediatric emergency department (ED) and to identify headache characteristics which are more likely associated with serious, life-threatening conditions in distinction from headaches due to more benign processes.Background.-Although headache is a common problem in children visiting a pediatric ED, a few studies thus far have attempted to identify the clinical characteristics most likely associated with suspected life-threatening disease.Methods.-A retrospective chart review of all consecutive patients who presented with a chief complaint of headache at ED over a 1-year period was conducted. Etiologies were classified according to the International Headache Society diagnostic criteria 2nd edition.Results.-Four hundred and thirty-two children (0.8% of the total number of visits) aged from 2 to 18 years (mean age 8.9 years) were enrolled in our study. There were 228 boys (53%) and 204 girls (47%). School-age group was the most represented (66%). The most common cause of headache was upper respiratory tract infections (19.2%). The remaining majority of non-life-threatening headache included migraine (18.5%), posttraumatic headache (5.5%), tension-type headache (4.6%). Serious life-threatening intracranial disorders (4.1%) included meningitis (1.6%), acute hydrocephalus (0.9%), tumors (0.7%). We found several clinical clues which demonstrated a statistically significant correlation with dangerous conditions: pre-school age, recent onset of pain, occipital location, and child's inability to describe the quality of pain and objective neurological signs.Conclusions.-Differential diagnosis between primary and secondary headaches can be very difficult, especially in an ED setting. The majority of headaches are secondary to respiratory infectious diseases and minor head trauma. Our data allowed us to identify clinical features useful to recognize intracranial life-threatening conditions.