Headache Assessment of Children for Emergent Intracranial Abnormalities

儿童突发颅内异常的头痛评估

• 批准号: 10559250
• 负责人: Daniel Sing-Kwong Tsze
• 金额: $ 16.02万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10559250
• 关键词: 17 year old; Accident and Emergency department; Applied Research; Brain; Caregivers; Caring; Child; Child Care; Consultations; Data; Diagnostic; Emergency Care; Emergency Situation; Emergency department visit; Enrollment; Ensure; Ethnic Origin; Exposure to; Goals; Headache; Hemorrhage; Image; Insurance Coverage; Intervention; Knowledge; Multicenter Studies; Neurologist; Neurology; Outpatients; Race; Risk; Stroke; Time; Underinsured; brain abnormalities; care providers; experience; follow-up; improved; neuroimaging; pediatric emergency; prospective; racial and ethnic; risk stratification; symptom management; tool; tumor

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.

项目摘要 每年，超过400，000名儿童因头痛前往美国各地的急诊室（ED）， 他们的主要抱怨。虽然这些孩子中有一小部分（0.5-1%）会有大脑异常 需要紧急鉴定，如肿瘤，出血或中风，更大比例的人经历了 大约有三分之一的头痛儿童接受了 不必要的成像，增加了他们暴露于与神经成像相关的风险。的目标 儿童急性颅内压综合征头痛评估（HEADACHE）研究旨在 生成明确的证据，帮助临床医生确定紧急颅内异常的风险， 帮助确定神经成像需求。HEADACHE的主要目的是推导和内部验证一个 这是一个对患有头痛的ED儿童的风险进行分层的决策工具。头痛是一种前瞻性的 一项多中心研究，计划入组28，000名2-17岁的头痛儿童，表现为18个ED之一 儿科急诊应用研究网络（PECARN）儿童头痛的随访 对于提供最佳症状管理和确保必要的诊断或 获得咨询，特别是如果在ED中没有获得神经影像学检查。 确定是否存在差异，在访问及时跟进儿童头痛评估ED。 及时随访可包括初级保健提供者（PCP）随访、神经病学随访或门诊随访 神经影像学检查。这一多样性补充将通过深入了解 了解头痛儿童的照顾者所经历的障碍和挑战， 在初次艾德就诊后为孩子寻求后续护理。这种多样性补充的具体目标 （1）确定保险状况和/或种族/民族是否与时间独立相关 建议的随访率，看PCP或神经科医生，（2）确定保险是否 状态和/或种族/民族独立地与获得神经成像和类型相关。 艾德出院后获得的神经影像学，（3）定量和定性探讨照顾者的 生活经验，以确定保险不足/公共保险中及时进行PCP或神经病学随访的障碍 和/或种族/民族少数民族儿童因头痛而到艾德就诊。