Agostoni E, Santoro P, Frigerio R, Frigo M, Beghi E, Ferrarese C
Stroke Unit, Centro Cefalee, Clinica Neurologica, Università degli Studi Milano Bicocca, Ospedale San Gerardo, Via Donizetti 106, I-20052 Monza (MI), Italy.
Neurol Sci. 2004 Oct;25 Suppl 3:S187-9. doi: 10.1007/s10072-004-0282-8.
Headache is one of the most common symptoms that leads patients to the emergency room (ER) and is often related to diseases requiring prompt diagnosis and immediate treatment. This consideration brought us to consider the importance of the neurologist in improving the management of patients arriving in the ER with headache. We carried out a study for testing the degree of agreement between ER physician and neurologist using patient evaluation at headache centre (HC) as the gold standard. One hundred and seventeen patients with idiopathic (78) or symptomatic (39) headache were evaluated by the ER physician, the ER neurologist and the HC expert. The ER physician and the HC expert reached a fair agreement (Kappa=0.40); the other two pairs reached a moderate agreement (Kappa=0.57-0.60). There was no significant difference in the agreement of the three evaluators in patients with impairment of daily living activities or aged over 40. The agreement between the ER physician and the neurologist was lower (Kappa=0.58), especially in patients with their first headache episode. Based on our results, patients seen at the ER for a headache episode can be fairly successfully managed by the ER physician, except those who present a first attack, for whom neurological consultation is needed.
头痛是导致患者前往急诊室（ER）的最常见症状之一，且常常与需要迅速诊断和立即治疗的疾病相关。这种考虑使我们认识到神经科医生在改善头痛患者急诊管理方面的重要性。我们进行了一项研究，以头痛中心（HC）的患者评估作为金标准，来测试急诊医生与神经科医生之间的一致程度。117例特发性（78例）或症状性（39例）头痛患者接受了急诊医生、急诊神经科医生和头痛中心专家的评估。急诊医生与头痛中心专家达成了中等程度的一致（Kappa = 0.40）；另外两组达成了中等偏高的一致（Kappa = 0.57 - 0.60）。在日常生活活动受限的患者或40岁以上的患者中，三位评估者的一致性没有显著差异。急诊医生与神经科医生之间的一致性较低（Kappa = 0.58），尤其是在首次头痛发作的患者中。根据我们的研究结果，因头痛发作前往急诊室就诊的患者，除首次发作的患者需要进行神经科会诊外，急诊医生能够相当成功地对其进行管理。
