加拿大头痛协会关于急诊科急性偏头痛诊断的标准——我们的患者符合这些标准吗？

Canadian Headache Society criteria for the diagnosis of acute migraine headache in the ED--do our patients meet these criteria?

作者信息

Fiesseler Frederick W, Riggs Renee L, Holubek William, Eskin Barnet, Richman Peter B

机构信息

Department of Emergency Medicine, Morristown Memorial Hospital, NJ 07962, USA.

出版信息

Am J Emerg Med. 2005 Mar;23(2):149-54. doi: 10.1016/j.ajem.2004.03.001.

DOI:10.1016/j.ajem.2004.03.001

PMID:15765334

Abstract

INTRODUCTION

We previously reported that many patients who present to the ED with "migraine" headache do not meet the International Headache Society criteria (IHSC) for the diagnosis of acute migraine. Objective The aim of the study was to compare the frequency for which ED patients with migraine headache meet the Canadian Headache Society criteria (CHSC) vs the IHSC.

METHODS

This was a prospective, observational study, performed at a community ED. Consecutive patients who presented to study authors with a chief complaint of headache were enrolled. Historical/clinical data were collected on a standardized form. Ninety-five percent confidence intervals (95% CIs) were calculated and Fisher exact test was used as appropriate.

RESULTS

One hundred eighty-nine patients were enrolled in this study. Mean age was 38 years. Females comprised 69% of patients. Thirty-seven percent of patients had prior ED visits for headaches. A positive family history of migraines was present in 35% of patients. Diagnostic imaging was previously performed in 44 of the enrollees to evaluate the cause of their headaches. A total of 43 (23%) patients had a prior diagnosis of migraine. Overall CHSC was met in 18% of patients, compared with 15% of patients who met IHSC. Discharge diagnosis of migraine was made in 41% of patients. Of these patients, 33% met CHSC and 28% met IHSC (P=.30). For patients with discharge diagnosis of migraine, 33% of females and 36% of males fit CHSC (P=.53), whereas 26% and 36% met IHSC (P=.34), respectively. For patients with a prior diagnosis of migraine, 32% met CHSC and 26% met IHSC (P=.24). Patients with a prior diagnosis of migraine and/or a discharge diagnosis of migraine met CHSC 31% (95% CI, 22%-40%) of the time vs 25% for the IHSC (95% CI, 16%-34%) (P=.26). Four patients without a discharge and/or previous diagnosis of migraine met CHSC; 3 met IHSC.

CONCLUSIONS

In our study population, only a minority of patients with headache who have prior diagnosis and/or ED diagnosis of migraine headache met CHSC. The utility of CHSC and/or IHSC to standardize ED patients for headache research may be limited.

摘要

引言

我们之前报道过，许多因“偏头痛”头痛而前往急诊科就诊的患者并不符合国际头痛协会（IHSC）对急性偏头痛的诊断标准。目的本研究旨在比较偏头痛性头痛的急诊科患者符合加拿大头痛协会（CHSC）标准与符合IHSC标准的频率。

方法

这是一项在社区急诊科进行的前瞻性观察性研究。纳入以头痛为主诉前来就诊的连续患者。通过标准化表格收集历史/临床数据。计算95%置信区间（95%CI），并在适当情况下使用Fisher精确检验。

结果

本研究共纳入189例患者。平均年龄为38岁。女性占患者的69%。37%的患者曾因头痛前往急诊科就诊。35%的患者有偏头痛家族史阳性。44名受试者之前曾进行诊断性影像学检查以评估其头痛原因。共有43例（23%）患者之前被诊断为偏头痛。总体而言，18%的患者符合CHSC标准，而符合IHSC标准的患者为15%。41%的患者出院诊断为偏头痛。在这些患者中，33%符合CHSC标准，28%符合IHSC标准（P = 0.30）。对于出院诊断为偏头痛的患者，33%的女性和36%的男性符合CHSC标准（P = 0.53），而分别有26%和36%符合IHSC标准（P = 0.34）。对于之前被诊断为偏头痛的患者，32%符合CHSC标准，26%符合IHSC标准（P = 0.24）。之前被诊断为偏头痛和/或出院诊断为偏头痛的患者符合CHSC标准的时间为31%（95%CI，22% - 40%），而符合IHSC标准的时间为25%（95%CI，16% - 34%）（P = 0.26）。4例无出院和/或既往偏头痛诊断的患者符合CHSC标准；3例符合IHSC标准。