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Headache in the pediatric emergency service: a medical center experience
Hsiang-Ju Hsiao1, Jing-Long Huang2, Shao-Hsuan Hsia2
1Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Insights
In pediatric emergency departments, headache is common. Blurred vision and ataxia are key indicators of serious intracranial pathology in children with headaches.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Clinical Diagnostics
Background:
- Headache is a frequent pediatric complaint, often leading to emergency department visits.
- Understanding headache etiologies and predictors of serious conditions is crucial for timely intervention.
- Developing efficient screening tools for pediatric headaches is a clinical need.
Purpose of the Study:
- To describe the causes of headaches in children presenting to a pediatric emergency department.
- To identify predictors of intracranial pathology requiring urgent intervention.
- To develop practical screening tools for pediatric headaches.
Main Methods:
- Retrospective chart review of pediatric emergency department visits for headache in 2008.
- Identification of red flag symptoms and neurological examination findings.
- Analysis of brain computed tomography results to detect intracranial pathology.
Main Results:
- Headache was the chief complaint in 0.9% of 43,913 pediatric emergency department visits.
- Acute viral, respiratory, and febrile illnesses were the most common causes (59.9%).
- Six children (1.5%) had life-threatening intracranial pathology; blurred vision and ataxia were significantly more prevalent in this group.
Conclusions:
- Blurred vision and ataxia are significant clinical predictors of intracranial pathology in children with headaches.
- These findings can aid in developing rapid screening tools for pediatric headaches.
Background:
Headache is a common complaint in children and is one of the most common reasons for presentation at a pediatric emergency department (PED). This study described the etiologies of patients with headache seen in the PED and determined predictors of intracranial pathology (ICP) requiring urgent intervention. A secondary objective was to develop rapid, practical tools for screening headache in the PED.
Methods:
We conducted a retrospective chart review of children who presented with a chief complaint of headache at the PED during 2008. First, we identified possible red flags in the patients' history or physical examination and neurological examination findings. Then, we recorded the brain computed tomography results.
Results:
During the study period, 43,913 visits were made to the PED; in 409 (0.9%) patients, the chief complaint was headache. Acute viral, respiratory, and febrile illnesses comprised the most frequent cause of headache (59.9%). Six children (1.5%) had life-threatening ICP findings. In comparison with the group without ICP, the group with ICP had a significantly higher percentage of blurred vision (p = 0.008) and ataxia (p = 0.002).
Conclusion:
Blurred vision and ataxia are the best clinical parameters to predict ICP findings.
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