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Headache Assessment of Children for Emergent Intracranial Abnormalities

儿童突发颅内异常的头痛评估

基本信息

批准号：
10247083
负责人：
Daniel Sing-Kwong Tsze
金额：
$ 133.5万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-01 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10247083
关键词：
17 year old Academy Accident and Emergency department Acute Adverse event Age American Applied Research Brain Brain Neoplasms Characteristics Child Clinical Communities Craniocerebral Trauma Diagnosis Diagnostic Emergency Care Emergency Department Physician Emergency Medicine Enrollment Exposure to Goals Headache Hemorrhage Intervention Intracranial Hemorrhages Knowledge Lead Magnetic Resonance Imaging Malignant Neoplasms Methodology Methods Migraine Minor Modeling Morbidity - disease rate Multicenter Trials Neurology Patients Pediatric Neurology Physical Examination Physicians Prevalence Prospective Studies Radiation Radiation Dose Unit Recommendation Recording of previous events Research Respiratory Tract Infections Risk Risk Estimate Risk Factors Role Sample Size Scanning Secondary to Sedation procedure Signs and Symptoms Sleep Societies Statistical Models Stroke Testing Uncertainty X-Ray Computed Tomography base brain abnormalities cancer risk clinical decision support computerized decision making algorithm design high risk improved lifetime risk neuroimaging pediatric emergency pediatrician prevent prospective radiation risk research study risk stratification support tools tool tumor

项目摘要

Project Summary More than 400,000 children present annually to emergency departments (EDs) in the U.S. with chief complaints of headaches. A small but meaningful proportion (0.5-1%) of these children will have abnormalities in the brain requiring emergent identification, such as tumors, bleeding, or strokes. However, a much larger proportion undergo neuroimaging of the brain in the ED, with up to one-third of children with headaches being unnecessarily exposed to the risks associated with neuroimaging. The most prominent of these risks is a lethal malignancy due to radiation from computed tomography (CT) scanning. The primary reason for the overuse of neuroimaging in the ED is the lack of clarity regarding which clinical characteristics, or “red flag” findings, accurately identify children with headaches who are at risk of having emergent brain abnormalities. Current red flag findings were discovered from studies that were limited in their methods and/or had small numbers of patients; in fact, frequently used red flag findings (e.g. headache waking the patient from sleep) are common and non-specific, with certain findings occurring in as many as 30-40% of children with headaches. The long- term goal of our research is to widely implement a decision support tool that will help clinicians make balanced and informed decisions based on precise estimates of the risk of emergent brain abnormalities in children with headaches. The goal of the current study is to generate the definitive evidence that will allow clinicians to identify the risks of emergent brain abnormalities in otherwise healthy children presenting to EDs with headaches. The primary aim of our current study is to derive and internally validate a decision tool that stratifies the risk for children presenting to EDs with headaches. This model will use clinically sensible and reliable factors to identify children at near-zero risk of emergent brain abnormalities with near perfect accuracy. We will accomplish this aim by conducting a prospective multicenter research study in which we enroll 28,000 children 2 to 17-years-old with headaches presenting to one of 18 EDs in the Pediatric Emergency Care Applied Research Network (PECARN). We will prospectively collect a comprehensive list of history and physical examination findings for these patients and use sophisticated statistical modeling analyses to derive a model to stratify risk. We aim to derive a model which is highly accurate for identifying patients at near-zero risk of emergent brain abnormalities. The availability of a decision tool which identifies children with near-zero risk and higher risk of emergent brain abnormalities based on specific headache characteristics will fundamentally improve how children with acute headaches are managed. This information will help optimize the use of emergent neuroimaging, including the safe reduction of unnecessary neuroimaging in children.

项目总结