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Published on: June 2, 2014
Management of pediatric migraine in a tertiary care versus community based emergency department: an observational
Amy Eapen1, Rajkumar Agarwal2, Ronald Thomas3
1Wayne State University School of Medicine, Detroit, Michigan.
Insights
Emergency departments show varied pediatric migraine treatments. Community settings more frequently use opiates and imaging, unlike tertiary care, highlighting a need for standardized, evidence-based care to improve migraine management.
Area of Science:
- Neurology
- Emergency Medicine
- Pediatrics
Background:
- Pediatric migraine management in emergency departments lacks standardized guidelines, leading to institutional treatment variations.
- This study compares pediatric migraine treatment strategies between community-based and tertiary care emergency departments.
Purpose of the Study:
- To characterize and compare management strategies for pediatric migraine in emergency departments.
- To identify differences in patient demographics and treatment approaches between two distinct healthcare settings.
Main Methods:
- Retrospective cohort study of pediatric patients meeting International Classification of Headache Disorders-2 migraine criteria.
- Comparison of patient demographics and treatment modalities between a tertiary care and a community-based emergency department.
Main Results:
- Significant differences observed in opiate use (7.6% vs. 33%), neuro-imaging (6.3% vs. 20.6%), and hospital admission rates (22% vs. 0%) between sites.
- Tertiary care EDs showed higher use of NSAIDs/serotonin agonists at discharge (72.7% vs. 22.2%).
- Opiate use and intravenous combination therapy predicted hospital admission.
Conclusions:
- Low utilization of intravenous combination therapy, antidopaminergic agents, and serotonin agonists noted in both settings.
- Community-based physicians demonstrated higher rates of opiate administration and neuro-imaging compared to academic settings.
- Standardized, evidence-based acute care plans are crucial for better episodic migraine control and reduced emergency department visits.
Background:
Because of a lack of guidelines for the management of pediatric migraine in the emergency department setting, marked variations in treatment protocols exist between institutions. We aimed to characterize differences in management strategies for pediatric migraine treatment between a community-based and a tertiary care emergency department.
Methods:
A retrospective cohort study was performed to include pediatric patients presenting with headache fulfilling the International Classification of Headache Disorders-2 migraine criteria in a tertiary care (site 1) and a community based (site 2) emergency department. The two sites were compared with respect to patient demographics and approach to treatment.
Results:
A total of 158 patients at site 1 (mean age 13.6 years, 70% female, 68% African-American) and 63 patients at site 2 (mean age 16.7 years, 71% female, 100% Caucasian) were analyzed. Opiate use (7.6% vs. 33%), imaging (6.3% vs. 20.6%), use of nonsteroidal anti-inflammatory drugs/serotonin agonists at discharge (72.7% vs. 22.2%), and admission rates to hospital (22% vs. 0%) were significantly different. Logistic regression analysis indicated that the main predictors of hospital admission were use of opiates and intravenous combination abortive therapy.
Conclusion:
Low rates of intravenous combination therapy, antidopaminergic agent, and serotonin agonist use were noted across both hospital settings. Community-based physicians used opiates and obtained neuro-imaging more than those in the academic setting. Standardization of care in the emergency setting coupled with reliable acute care plans that are based on evidenced-based guidelines can allow for better control of episodic migraine and reduce emergency department visits.
