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Practice variation after implementation of a protocol for migraines in children
Evelyne D Trottier1, Benoit Bailey, Sabine Dauphin-Pierre
1Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.
Insights
Pediatric migraine treatment evolved over a decade following protocol implementation in an emergency department (ED). More children received care, and treatment approaches changed significantly, indicating protocol effectiveness.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Clinical Protocol Implementation
Background:
- Migraine is a common neurological disorder in children.
- Standardized treatment protocols can improve care in emergency settings.
- Evaluating treatment changes over time is crucial for evidence-based practice.
Purpose of the Study:
- To assess the impact of a migraine treatment protocol on care in a pediatric emergency department.
- To analyze changes in migraine treatment patterns over a 10-year period.
- To compare patient demographics and medication use before and after protocol implementation.
Main Methods:
- Comparative retrospective chart review of pediatric migraine patients.
- Two distinct 2-year study periods: 1996-1997 and 2006-2007.
- Analysis of treatment protocols implemented in 1999.
Main Results:
- Increased patient visits for migraine (144 vs. 182) and higher treatment rates (30% vs. 50%) in the later period.
- Significant variations observed in the types of medications used for pediatric migraine treatment.
- The 10-year study demonstrated a 20% increase in treated patients.
Conclusions:
- Implementation of a pediatric migraine treatment protocol led to observable changes in emergency department care.
- Treatment strategies for pediatric migraine evolved over the study period.
- Protocols can influence clinical practice patterns in pediatric emergency medicine.
Abstract:
The objective of this study was to evaluate the changes that occurred in the treatment of migraine over a 10-year period in a pediatric emergency department (ED) after the implementation of a protocol. The method employed was a comparative retrospective chart review of children diagnosed with migraine in an ED. The two study periods were 1996-1997, and 2006-2007. A protocol suggesting a specific approach was implemented in the ED in 1999. The primary outcome was the medications used in the ED. There were 182 visits for migraine in 2006-2007 compared with 144 visits in 1996-1997. More patients were treated in the ED in 2006-2007 compared with 1996-1997: 50 versus 30%, a difference of 20% (95% confidence interval: 9, 30). The treatments used were also different. In conclusion, a variation in the treatment of migraine was observed over a 10-year period in a pediatric ED after the implementation of a treatment protocol.
