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Comprehensive Migraine Initiative in the Pediatric Emergency Department Improves Treatment Outcomes
Clare E Skora1, Lila T Worden2, Chris B Oakley1
1Department of Pediatric Neurology, Johns Hopkins Hospital, Baltimore, MD, USA.
Insights
A new comprehensive migraine initiative significantly improved pediatric emergency department care. Standardized protocols reduced pain and treatment time for pediatric migraine patients, enhancing overall treatment effectiveness and efficiency.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Quality Improvement
Background:
- Pediatric migraine accounts for 1% of emergency department visits.
- Significant variability exists in current pediatric migraine treatment practices.
- Limited research evaluates clinical effectiveness and timeliness after protocol implementation.
Purpose of the Study:
- To compare the efficacy of pediatric migraine treatment in the emergency department.
- To assess treatment outcomes before and after implementing a comprehensive migraine initiative.
- To evaluate the impact of standardized protocols, provider education, and documentation on care.
Main Methods:
- Single-center retrospective chart review.
- Comparison of pediatric patients before and after initiative implementation.
- Analysis included pain scores, pain reduction percentages, and time to treatment.
Main Results:
- The initiative group showed a significant reduction in headache pain score (5.9 vs 4.8, P=.006).
- A higher percentage of patients achieved ≥50% pain reduction in the initiative group (82% vs 67%, P=.039).
- Time to treatment significantly decreased in the initiative group (1.8 vs 2.1 hours, P=.046).
Conclusions:
- A comprehensive migraine initiative improved efficacy and efficiency of pediatric emergency department migraine treatment.
- Standardized protocols, provider education, and streamlined documentation are key components.
- The initiative led to better pain management and faster treatment delivery for pediatric patients.
Objective:
To compare pediatric migraine treatment efficacy in the emergency department before and after the implementation of a comprehensive migraine initiative, consisting of a standardized treatment protocol, provider educational series and standardized physician documentation template.
Background:
Pediatric migraine is common, accounting for 1% of pediatric emergency department visits. Yet there is large variability in treatment practices, with few studies looking into measures of both clinical effectiveness and timeliness of treatment following implementation of standardized protocols.
Methods:
A single-center retrospective chart review of pediatric patients presenting to the emergency department with migraine before and after implementation of an institutional headache initiative designed to more effectively and efficiently deliver care to pediatric migraine patients.
Results:
The study yielded 110 patients each in the intervention and preintervention groups. There were no significant differences in patient characteristics with respect to age, gender, or initial pain score. Compared with the preintervention group, the intervention group demonstrated a significant reduction in headache pain score prior to discharge (decrease of 5.9 vs 4.8 in preintervention group, P value .006) with a greater percentage of patients achieving ≥50% reduction in pain (82% vs 67% in preintervention group, P value .039). Additionally, we found a significantly decreased time to treatment in the intervention group compared with the preintervention group (1.8 vs 2.1 hours, P value .046).
Conclusion:
Through the use of a standardized treatment protocol, improved provider education, and ease of documentation, this comprehensive migraine initiative improved efficacy and efficiency of migraine treatment in the pediatric emergency department.
