1
|
Granato A, D'Acunto L, Morelli ME, Bellavita G, Cominotto F, Manganotti P. Lost diagnoses in not otherwise specified headache in Emergency Department. Acta Neurol Belg 2022; 122:129-134. [PMID: 34449048 PMCID: PMC8894300 DOI: 10.1007/s13760-021-01687-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/23/2021] [Indexed: 11/30/2022]
Abstract
The diagnosis of Not Otherwise Specified (NOS) headaches in the Emergency Department (ED) is frequent despite many specialist visits performed. The aim of the study was to examine specialist visits carried out in the patients discharged from ED with diagnosis of NOS headache to evaluate discrepancies between specialist and ED diagnosis at discharge. We retrospectively (1.6.2018–31.12.2018) analyzed all the patients admitted with non-traumatic headache to the ED of the tertiary-care University Hospital of Trieste. We evaluated the patients discharged from ED with a final diagnosis of NOS headache and who underwent at least one specialist examination. Demographic data, specialist and ED diagnosis were analyzed. One hundred twenty-four patients (93 F, 31 M, mean age 44 ± 15 years) were included. 71.8% of patients were examined only by a neurologist, 12.9% by non-neurologists, 15.3% by both neurologist and non-neurologist. Only 37% of the patients received a precise diagnosis. Neurologist made a diagnosis slightly more frequently than the other consultants (40.5% vs 37.5%). Neurologists diagnosed primary headaches, headaches secondary to neurological diseases, and facial neuralgia, instead non-neurologists diagnosed only headaches secondary to non-neurological diseases. Primary headaches were diagnosed in 25.7% of cases, migraine being the most frequent. Physicians did not report any specialist diagnoses in the ED discharge sheet. Specialist consultants made specific diagnoses in about one-third of patients that were not reported as final in the discharge records by the ED physician. This leads to a loss of diagnoses and to an overestimation of NOS headache.
Collapse
Affiliation(s)
- Antonio Granato
- Clinical Unit of Neurology, Headache Centre, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste-ASUGI, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Laura D'Acunto
- Clinical Unit of Neurology, Headache Centre, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste-ASUGI, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Maria Elisa Morelli
- Clinical Unit of Neurology, Headache Centre, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste-ASUGI, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Giulia Bellavita
- Clinical Unit of Neurology, Headache Centre, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste-ASUGI, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Franco Cominotto
- Emergency Department, University Hospital and Health Services of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Headache Centre, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste-ASUGI, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
| |
Collapse
|
2
|
Mostardini C, d'Agostino VC, Dugoni DE, Cerbo R. A Possible Role of ID-Migraine™ in the Emergency Department: Study of an Emergency Department Out-Patient Population. Cephalalgia 2009; 29:1326-30. [DOI: 10.1111/j.1468-2982.2009.01889.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Headache symptoms account for 1-3% of admissions to an emergency department (ED). Most patients affected by a primary headache (PH) have migraine, although they are often misdiagnosed as ‘headache not otherwise specified’. We investigated the possibility of using ID-Migraine (ID-M) to improve migraine recognition in the ED setting. We planned a pilot study involving ED out-patients with a diagnosis of PH. Diagnoses of a blinded headache expert were subsequently matched with the ID-M results. We tested ID-M on 230 patients (199 PH, 31 secondary headaches). Considering only PH, ID-M exhibited a sensitivity of 0.94 and specificity of 0.83 with a positive predictive value (PPV) of 0.99. The ID-M is a simple migraine screener with high sensitivity, high specificity and high PPV, even in an ED-derived population. Methodical use of this tool in an ED setting may, once a secondary headache has been excluded, lead to rapid diagnosis of migraine.
Collapse
Affiliation(s)
- C Mostardini
- Emergency Department Headache Centre, ‘Enzo Borzomati’ Pain Centre, Emergency Department, Azienda Policlinico Umberto I, ‘Sapienza’ University, Rome, Italy
| | - VC d'Agostino
- Emergency Department Headache Centre, ‘Enzo Borzomati’ Pain Centre, Emergency Department, Azienda Policlinico Umberto I, ‘Sapienza’ University, Rome, Italy
| | - DE Dugoni
- Emergency Department Headache Centre, ‘Enzo Borzomati’ Pain Centre, Emergency Department, Azienda Policlinico Umberto I, ‘Sapienza’ University, Rome, Italy
| | - R Cerbo
- Emergency Department Headache Centre, ‘Enzo Borzomati’ Pain Centre, Emergency Department, Azienda Policlinico Umberto I, ‘Sapienza’ University, Rome, Italy
| |
Collapse
|
3
|
Valade D. The Emergency Headache Center at the Lariboisière Hospital: 7 years with more than 70,000 patients. Intern Emerg Med 2008; 3 Suppl 1:S3-7. [PMID: 18785014 DOI: 10.1007/s11739-008-0191-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
After 7 years and 70,000 patients of whom two-thirds women and one-third men, 77% aged 20-50 years, 90% residing in Paris or the suburban areas, we report our experience at the Lariboisière hospital Emergency headache Center. About two-thirds of our patients complained of primary headache, i.e., migraine, but the number of patients with secondary headache has progressively increased to account for about 17.3% of our current recruitment. Vascular headache, particularly after meningeal bleeding has been prevalent leading to an increased number of orders for laboratory and radiological investigations as well as hospitalizations.
Collapse
Affiliation(s)
- Dominique Valade
- Emergency Headache Center, Lariboisière Hospital, 2 rue Ambroise Paré, 75010 Paris, France.
| |
Collapse
|
4
|
Scagni P, Pagliero R. Headache in an Italian pediatric emergency department. J Headache Pain 2008; 9:83-7. [PMID: 18250964 PMCID: PMC3476181 DOI: 10.1007/s10194-008-0014-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 01/03/2008] [Accepted: 01/08/2008] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to assess epidemiology, diagnostic work-up, treatment and follow-up of children presenting to emergency department (ED) with headache. Records of visits for non-traumatic headache to the ED of a pediatric hospital over a period of 12 months were retrospectively reviewed. Headache center charts were analyzed one year after. Five-hundred and fifty patients (1% of all ED visits) were included. Spectrum of diagnoses was: primary headache (56.7%), with 9.6% of migraine; secondary headache (42%); unclassified headache (1.3%). Viral illnesses accounted for 90.5% of secondary headaches. A serious disorder was found in 4% of patients. Forty-four patients (8%) underwent neuroimaging studies, with 25% of abnormal findings. Only 223 patients (40.5%) received pharmacological treatment. On discharge, 212 patients (38.5%) were referred to headache center and 114 (20.7% of all patients) attended it. ED diagnosis was confirmed in 74.6% of cases. Most of ED repeated visits (82.6%) occurred in patients not referred to headache center at discharge from first ED visit. The most frequent diagnosis was primary headache; viral illnesses represented the majority of secondary headaches. Underlying serious disorders were associated with neurological signs, limiting the need of diagnostic investigations. Well structured prospective studies are needed to evaluate appropriate diagnostic tools, as well as correct therapeutic approach of pediatric headache in emergency. Collaboration with headache center might limit repeated visits and provide a correct diagnostic definition.
Collapse
Affiliation(s)
- Paola Scagni
- Department of Pediatrics, Headache Center, Children's Hospital Regina Margherita, P.zza Polonia 94, 10126 Torino, Italy.
| | | |
Collapse
|