Locker Thomas E, Thompson Catriona, Rylance Jamie, Mason Suzanne M
School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent St., Sheffield, S1 4DA UK.
Headache. 2006 Jun;46(6):954-61. doi: 10.1111/j.1526-4610.2006.00448.x.
When patients present to an emergency department because of nontraumatic headache, they often present a diagnostic challenge. This study aimed to examine the utility of clinical features in detecting serious underlying causes of nontraumatic headache in adult patients presenting to an emergency department.
A prospective observational study of alert adult patients presenting to 1 UK emergency department over a period of 14 months was conducted. Patients were excluded if their headache was related to trauma or they had been previously recruited into the study. A standardized data collection form was used to record details of the history and examination findings. Investigation and management were conducted according to the existing departmental protocols. Patients were followed up for 3 months following their initial presentation. Each factor in the history and examination was examined for its ability to predict a serious underlying cause of headache.
Five hundred and eighty-nine patients were included in the study with complete follow-up details obtained on 558 (94.7%) patients. Seventy-five (13.4%) patients were found to have a serious pathological cause of their headache. Four features were found to be significant independent predictors of serious pathology, these were age >50 years (likelihood ratio (LR) = 2.34), sudden onset, (LR = 1.74), any abnormality on neurological examination (LR = 3.56), and presentation due to associated features (LR = 2.27). Taken in combination, the presence of any 1 of the first 3 features has a sensitivity of 98.6% and specificity of 34.4% (Positive LR = 1.50, Negative LR = 0.04).
Three features, age greater than 50, sudden onset, and an abnormal neurological examination, are identified as significant independent predictors of serious pathology, which, in combination, can exclude the presence of such pathology in adult patients presenting with nontraumatic headache.
当患者因非创伤性头痛前往急诊科就诊时，常常带来诊断挑战。本研究旨在探讨临床特征在检测前往急诊科就诊的成年患者非创伤性头痛的严重潜在病因方面的效用。
对在14个月期间前往英国一家急诊科就诊的神志清醒的成年患者进行了一项前瞻性观察性研究。如果患者的头痛与创伤有关或他们之前已被纳入该研究，则将其排除。使用标准化的数据收集表记录病史和检查结果的详细信息。根据现有的科室方案进行检查和处理。患者在首次就诊后随访3个月。对病史和检查中的每个因素预测头痛严重潜在病因的能力进行了检查。
589例患者纳入本研究，558例（94.7%）患者获得了完整的随访细节。75例（13.4%）患者被发现有头痛的严重病理原因。发现四个特征是严重病理的显著独立预测因素，分别是年龄>50岁（似然比（LR）=2.34）、突然发作（LR = 1.74）、神经科检查有任何异常（LR = 3.56）以及因相关特征就诊（LR = 2.27）。综合来看，前三个特征中任何一个的存在敏感性为98.6%，特异性为34.4%（阳性似然比 = 1.50，阴性似然比 = 0.04）。
三个特征，即年龄大于50岁、突然发作和神经科检查异常，被确定为严重病理的显著独立预测因素，综合起来可排除非创伤性头痛成年患者中此类病理的存在。
