 |
|
Predictors of Intracranial Pathologic Findings in Patients Who Seek Emergency Care Because of Headache
Manuel Ramirez-Lassepas, MD;
Carlos E. Espinosa, MD;
James J. Cicero, MD;
Kathleen L. Johnston;
Robert J. Cipolle, PharmD;
Donald L. Barber, PharmD
Arch Neurol. 1997;54(12):1506-1509.
Abstract
Background
Clinical criteria to select patients with headache in whom structural diagnostic studies (computed tomography) have a high yield disclosing intracranial pathologic findings, independent of abnormal findings on neurologic examination, have not been defined.
Objective
To determine which clinical characteristics predict the presence of intracranial pathologic findings, independently of neurologic examination, in patients with headache.
Design
Case-control, consecutive sample. Setting: Major metropolitan trauma center emergency department.
Patients and Materials
Hospital records of 139 hospitalized and 329 randomly selected patients from 1720 nonhospitalized adult patients, consecutively evaluated for headache in the emergency department, were reviewed. Demographic data, clinical characteristics of the headache, results of neurologic and physical examinations, and diagnostic radiologic and laboratory results were correlated with final diagnosis and outcome at 6 months after emergency department visit.
Data Analysis
Nonparametric statistical analysis.
Results
Intracranial pathologic findings were found in 18 (3.8%) of 468 patients. Acute onset and occipitonuchal location of headache, presence of associated symptoms, and patient age of 55 years or older were significantly associated with the finding of intracranial pathology, independently of the findings from neurologic examination. Abnormal findings on neurologic examination alone, whether focal or non-focal, had a highly significant association and a positive predictive value for intracranial pathology of 39%.
Conclusions
Abnormal results from neurologic examination are the best clinical parameters to predict structural intracranial pathology; however, in patients 55 years or older with headache of acute onset located in the occipitonuchal region that has associated symptoms, computed tomgraphic scan of the head is justified as part of their clinical evaluation independently of the findings of the neurologic examination.
Author Affiliations
From the Departments of Neurology, St Paul-Ramsey Medical Center, St Paul, Minn (Drs Ramirez-Lassepas and Espinosa and Ms Johnston) and University of Minnesota, Minneapolis (Dr Ramirez-Lassepas); Department of Emergency Medicine, St Paul-Ramsey Medical Center (Dr Cicero); and College of Pharmacy, University of Minnesota (Drs Cipolle and Barber).
 CiteULike  Connotea  Delicious  Digg  Facebook  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Atraumatic headache in US emergency departments: recent trends in CT/MRI utilisation and factors associated with severe intracranial pathology
Gilbert et al.
Emerg. Med. J. 2011;0:emermed-2011-200088v1-emermed-2011-200088.
ABSTRACT
| FULL TEXT
High risk clinical characteristics for subarachnoid haemorrhage in patients with acute headache: prospective cohort study
Perry et al.
BMJ 2010;341:c5204-c5204.
ABSTRACT
| FULL TEXT
Missed Diagnosis of Subarachnoid Hemorrhage in the Emergency Department
Vermeulen and Schull
Stroke 2007;38:1216-1221.
ABSTRACT
| FULL TEXT
Should Spectrophotometry Be Used to Identify Xanthochromia in the Cerebrospinal Fluid of Alert Patients Suspected of Having Subarachnoid Hemorrhage?
Perry et al.
Stroke 2006;37:2467-2472.
ABSTRACT
| FULL TEXT
Does this patient with headache have a migraine or need neuroimaging?
Detsky et al.
JAMA 2006;296:1274-1283.
ABSTRACT
| FULL TEXT
Headache in United States Emergency Departments: Demographics, Work-up and Frequency of Pathological Diagnoses
Goldstein et al.
Cephalalgia 2006;26:684-690.
ABSTRACT
| FULL TEXT
Primary headache disorder in the emergency department: perspective from a general neurology outpatient clinic
Gahir and Larner
Emerg. Med. J. 2006;23:135-136.
ABSTRACT
| FULL TEXT
A Randomized Prospective Placebo-Controlled Study of Intravenous Magnesium Sulphate vs. Metoclopramide in the Management of Acute Migraine Attacks in the Emergency Department
Cete et al.
Cephalalgia 2005;25:199-204.
ABSTRACT
| FULL TEXT
Red flags in patients presenting with headache: clinical indications for neuroimaging
M et al.
Br. J. Radiol. 2003;76:532-535.
ABSTRACT
| FULL TEXT
Headache in the HIV Patient: A Review with Special Attention to the Role of Imaging
Graham and Wippold
Cephalalgia 2001;21:169-174.
ABSTRACT
| FULL TEXT
Practice parameter: Evidence-based guidelines for migraine headache (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology
Silberstein
Neurology 2000;55:754-762.
FULL TEXT
|
