| Atraumatic headache in US emergency departments: recent trends in CT/MRI utilisation and factors associated with severe intracranial pathology. | |
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MedLine Citation:
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PMID: 21856709 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Objectives To estimate recent trends in CT/MRI utilisation among patients seeking emergency care for atraumatic headache in the USA and to identify factors associated with a diagnosis of significant intracranial pathology (ICP) in these patients. Design/setting/participants Data were obtained from the USA National Hospital Ambulatory Medical Care Survey of emergency department (ED) visits between 1998 and 2008. A cohort of atraumatic headache-related visits were identified using preassigned 'reason-for-visit' codes. Sample visits were weighted to provide national estimates. Results Between 1998 and 2008 the percentage of patients presenting to the ED with atraumatic headache who underwent imaging increased from 12.5% to 31.0% (p<0.01) while the prevalence of ICP among those visits decreased from 10.1% to 3.5% (p<0.05). The length of stay in the ED was 4.6 h (95% CI 4.4 to 4.8) for patients with headache who received imaging compared with 2.7 (95% CI 2.6 to 2.9) for those who did not. Of 18 factors evaluated in patients with headache, 10 were associated with a significantly increased odds of an ICP diagnosis: age ≥50 years, arrival by ambulance, triage immediacy <15 min, systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg and disturbance in sensation, vision, speech or motor function including neurological weakness. Conclusions The use of CT/MRI for evaluation of atraumatic headache increased dramatically in EDs in the USA between 1998 and 2008. The prevalence of ICP among patients who received CT/MRI declined concurrently, suggesting a role for clinical decision support to guide more judicious use of imaging. |
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Authors:
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John W Gilbert; Kevin M Johnson; Gregory L Larkin; Christopher L Moore |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-8-19 |
Journal Detail:
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Title: Emergency medicine journal : EMJ Volume: - ISSN: 1472-0213 ISO Abbreviation: - Publication Date: 2011 Aug |
Date Detail:
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Created Date: 2011-8-22 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100963089 Medline TA: Emerg Med J Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Yale School of Medicine, New Haven, Connecticut, USA. |
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