Headache Assessment of Children for Emergent Intracranial Abnormalities

项目摘要 每年，超过40万名头痛儿童被送往美国各地的急诊科 他们的主要抱怨。虽然这些儿童中有一小部分(0.5%-1%)会有脑部异常 需要紧急识别的，如肿瘤、出血或中风，比例要大得多 急诊室的脑部神经成像。大约三分之一的头痛儿童正在接受 不必要的成像增加了他们暴露在与神经成像相关的风险中。的目标是 儿童头痛评估为急诊颅内畸形(头痛)研究 产生明确的证据，帮助临床医生确定紧急颅内异常的风险 帮助确定神经成像的需求。头痛的主要目标是派生并在内部验证 一种决策工具，可对患有头痛的儿童向急诊室提出的风险进行分层。头痛是一种潜在的 多中心研究计划招募28,000名2-17岁头痛儿童参加18家急诊室中的一家 在儿科急救应用研究网络(PECARN)。头痛儿童的随访 对于提供最佳症状管理和确保必要的诊断或 进行会诊，特别是在急诊室没有获得神经成像的情况下。然而，很少有数据显示 确定在急诊室评估的头痛儿童获得及时随访方面是否存在差异。 及时的随访可以包括初级保健提供者(PCP)的随访、神经科的随访或门诊 神经影像检查，如有指征。这一多样性补充将通过获得深入的研究来加强头痛的研究 了解头痛儿童的照顾者在以下情况下所经历的障碍和挑战 在第一次急诊室就诊后寻求对子女的后续照顾。这份多样性副刊的具体目的是 是：(1)确定保险状况和/或种族/民族是否与时间独立相关 去看初级保健医生或神经科医生的建议随访率，(2)确定是否投保 状态和/或种族/民族独立地与获得神经成像和 ED出院后获得的神经影像；(3)定量和定性地探讨照顾者的 在保险不足/公共保险的人群中发现及时进行PCP或神经学随访的障碍的亲身经历 和/或种族/族裔少数群体儿童因头痛向教育署提出报告。

Project Summary Annually, over 400,00 children present to emergency departments (EDs) across the U.S. with headaches as their chief complaints. Although a small proportion (0.5-1%) of these children will have brain abnormalities requiring emergent identification, such as tumors, bleeding, or strokes, a much larger proportion undergo neuroimaging of the brain in the ED. Approximately, one-third of children with headaches are receiving unnecessary imaging that increases their exposure to risk associated with neuroimaging. The goal of the Headache Assessment of Children for Emergency Intracranial Abnormalities (HEADACHE) study is to generate definitive evidence that will aid clinicians in determining risk of emergent intracranial abnormality to help identify need for neuroimaging. The primary aim of HEADACHE is to derive and internally validate a decision tool that stratifies the risk for children presenting to EDs with headaches. HEADACHE is a prospective multicenter study planning to enroll 28,000 children 2-17 years old with headaches presenting to one of 18 EDs in the Pediatric Emergency Care Applied Research Network (PECARN). Follow-up for children with headache is essential for providing optimal symptom management and ensuring that necessary diagnostics or consultations are obtained, particularly if neuroimaging is not obtained in the ED. Few data exist, however, to determine whether disparities exist in accessing timely follow-up for children with headaches evaluated in EDs. Timely follow up can include primary care provider (PCP) follow-up, neurology follow-up or outpatient neuroimaging if indicated. This diversity supplement will enhance the HEADACHE study by gaining an in-depth understanding of the barriers and challenges experienced by caregivers of children with headaches when seeking follow-up care for their children after the initial ED visit. The specific aims of this diversity supplement are: (1) to determine whether insurance status and/or race/ethnicity are independently associated with the time to and rate of recommended follow-up to see a PCP or a neurologist, (2) to determine whether insurance status and/or race/ethnicity are independently associated with obtaining neuroimaging and the type of neuroimaging obtained after ED discharge, and (3) to quantitatively and qualitatively explore the caregivers' lived experiences to identify barriers to timely PCP or neurology follow-up among underinsured/publicly insured and/or racial/ethnic minoritized children presenting to the ED with headaches.