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Serious Diagnoses for Headaches After ED Discharge
Amy Z Zhou1, Jennifer R Marin2,3, Robert W Hickey2
1Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois; zhou.amy@gmail.com.
Pediatrics
|October 3, 2020
Summary
A small percentage of children discharged from the emergency department with headaches are later diagnosed with serious neurologic and nonneurologic conditions. Identifying these at-risk pediatric patients remains a challenge for clinicians.
Area of Science:
- Pediatric Emergency Medicine
- Pediatric Neurology
- Clinical Epidemiology
Background:
- Headache is a frequent reason for pediatric emergency department visits.
- Serious neurologic and nonneurologic diagnoses (SNNDs) can underlie pediatric headaches.
- Characterizing children with SNNDs after ED discharge for headache is crucial.
Purpose of the Study:
- To determine the incidence and types of SNNDs in children discharged from the emergency department with a headache diagnosis.
- To compare the rates of SNNDs in headache patients with control groups.
Main Methods:
- A multicenter retrospective cohort study of over 121,000 pediatric patients was conducted.
- Patients discharged with headache were identified, excluding those with prior SNNDs.
- SNNDs diagnosed within 30 days of the initial visit were tracked and compared to control cohorts.
Main Results:
- 0.5% of pediatric patients discharged with headache were diagnosed with an SNND within 30 days.
- Benign intracranial hypertension, cerebral edema, and seizures were the most common SNNDs.
- Patients with SNNDs were more likely to undergo neuroimaging and laboratory testing.
Conclusions:
- A small but significant proportion of pediatric headache patients discharged from the ED are subsequently diagnosed with SNNDs.
- Identifying children at risk for SNNDs after an initial headache presentation requires further investigation.
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