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Atraumatic headache in US emergency departments: recent trends in CT/MRI utilisation and factors associated with severe intracranial pathology.
MedLine Citation:
PMID:  21856709     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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&emsp14;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&emsp14;years, arrival by ambulance, triage immediacy <15&emsp14;min, systolic blood pressure ≥160&emsp14;mm Hg or diastolic blood pressure ≥100&emsp14;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.
Authors:
John W Gilbert; Kevin M Johnson; Gregory L Larkin; Christopher L Moore
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-8-19
Journal Detail:
Title:  Emergency medicine journal : EMJ     Volume:  -     ISSN:  1472-0213     ISO Abbreviation:  -     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-8-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100963089     Medline TA:  Emerg Med J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Yale School of Medicine, New Haven, Connecticut, USA.
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