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Children under 6 years with acute headache in Pediatric Emergency Departments. A 2-year retrospective exploratory
Umberto Raucci1, Pasquale Parisi2, Valentina Ferro1
1Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Insights
In young children with acute headache, vomiting and ataxia are key indicators of potentially urgent intracranial conditions, not just age under six. Prompt evaluation of these symptoms is crucial for timely diagnosis and treatment.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Neuroimaging
Background:
- Acute headache in preschool children often prompts neuroimaging to rule out serious intracranial conditions.
- Previous assumptions suggested preschool age itself is a significant risk factor for dangerous headaches.
Purpose of the Study:
- To identify clinical features in preschoolers with acute headache that indicate a higher risk of secondary, potentially urgent intracranial conditions (PUIC).
- To re-evaluate the significance of preschool age as an independent risk factor for PUIC in acute headache presentations.
Main Methods:
- A multicenter, exploratory, retrospective study conducted in Italy (January 2017-December 2018).
- Inclusion of preschoolers with new-onset, non-traumatic headaches admitted to emergency departments.
- Comparison of clinical characteristics between hospitalized and discharged patients, with a focus on hospitalized cases to identify PUIC predictors.
Main Results:
- 1455 preschoolers with acute headache were included. Hospitalization was associated with vomiting, ocular motility disorders, ataxia, neurological signs, torticollis, and nocturnal awakening.
- Among 95 hospitalized patients, 34 (2.3%) had PUIC. These patients more frequently presented with neurological signs, papilledema, ataxia, cranial nerve paralysis, nocturnal awakening, and vomiting.
- Multivariable logistic regression identified only ataxia and vomiting as significant predictors of PUIC.
Conclusions:
- Specific clinical features like ataxia and vomiting are more critical than age alone in identifying preschoolers with acute headache who require urgent neuroimaging.
- The low prevalence of PUIC in this age group suggests that age under six may not be as strong a risk factor for malignant causes of headache as previously believed.
- These findings aid emergency departments in prioritizing diagnostic evaluations for acute headaches in young children.
Background:
Preschool age (i.e. children under six years of age) represents a red flag for requiring neuroimaging to exclude secondary potentially urgent intracranial conditions (PUIC) in patients with acute headache. We investigated the clinical characteristics of preschoolers with headache to identify the features associated with a greater risk of secondary "dangerous" headache.
Methods:
We performed a multicenter exploratory retrospective study in Italy from January 2017 to December 2018. Preschoolers with new-onset non-traumatic headache admitted to emergency department were included and were subsequently divided into two groups: hospitalized and discharged. Among hospitalized patients, we investigated the characteristics linked to potentially urgent intracranial conditions.
Results:
We included 1455 preschoolers with acute headache. Vomiting, ocular motility disorders, ataxia, presence of neurological symptoms and signs, torticollis and nocturnal awakening were significantly associated to hospitalization. Among the 95 hospitalized patients, 34 (2.3%) had potentially urgent intracranial conditions and more frequently they had neurological symptoms and signs, papilledema, ataxia, cranial nerves paralysis, nocturnal awakening and vomiting. Nevertheless, on multivariable logistic regression analysis, we found that only ataxia and vomiting were associated with potentially urgent intracranial conditions.
Conclusion:
Our study identified clinical features that should be carefully evaluated in the emergency department in order to obtain a prompt diagnosis and treatment of potentially urgent intracranial conditions. The prevalence of potentially urgent intracranial conditions was low in the emergency department, which may suggest that age under six should not be considered an important risk factor for malignant causes as previously thought.
