Headache in United States Emergency Departments Demographics, Work-up and Frequency of Pathological Diagnoses

• Published in: Cephalalgia Vol. 26; no. 6; pp. 684 - 690
• Main Authors: Goldstein, JN, Camargo, CA, Pelletier, AJ, Edlow, JA
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.06.2006; Blackwell Publishing Ltd
• Subjects: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; diagnosis; emergency department; Emergency Service, Hospital - utilization; etiology; Female; Headache; Headache - classification; Headache - diagnosis; Headache - epidemiology; Humans; Incidence; Male; Middle Aged; Practice Patterns, Physicians' - statistics & numerical data; Reproducibility of Results; Risk Assessment - methods; Risk Factors; Sensitivity and Specificity; Severity of Illness Index; Sex Distribution; Triage; United States; United States; Headache; diagnosis; emergency department; etiology
• ISSN: 0333-1024; 1468-2982
• DOI: 10.1111/j.1468-2982.2006.01093.x

Headache is a common complaint in the emergency department (ED). In order to examine headache work-ups and diagnoses across the USA, we queried a representative sample of adult ED visits (the National Hospital Ambulatory Medical Care Survey) for the years 1992–2001. Headache accounted for 2.1 million ED visits per year (2.2% of visits). Of the 14% of patients who underwent neuroimaging, 5.5% received a pathological diagnosis. Of the 2% of patients who underwent lumbar puncture, 11% received a pathological diagnosis. On multivariable analysis, a decreased rate of imaging was noted for patients without private insurance [odds ratio (OR) 0.61, confidence interval (CI) 0.44, 0.86] and for those presenting off-hours (OR 0.55, CI 0.39, 0.77). Patients over 50 were more likely to receive a pathological diagnosis (OR 3.3, CI 1.2, 9.3). In conclusion, clinicians should ensure that appropriate work-ups are performed regardless of presentation time or insurance status, and be vigilant in the evaluation of older patients.