Friedman Benjamin W, Serrano Daniel, Reed Michael, Diamond Merle, Lipton Richard B
Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY, NY 10467, USA.
Headache. 2009 Jan;49(1):21-30. doi: 10.1111/j.1526-4610.2008.01282.x. Epub 2008 Nov 25.
Although headache is a common emergency department (ED) chief complaint, the role of the ED in the management of primary headache disorders has rarely been assessed from a population perspective. We determined frequency of ED use and risk factors for use among patients suffering severe headache.
As part of the American Migraine Prevalence and Prevention study, a validated self-administered questionnaire was mailed to 24,000 severe headache sufferers, who were randomly drawn from a larger sample constructed to be sociodemographically representative of the US population. Participants were asked a series of questions on headache management, healthcare system use, sociodemographic features, and number of ED visits for management of headache in the previous 12 months. In keeping with the work of others, "frequent" ED use was defined as a participant's report of 4 or more visits to the ED for treatment of a headache in the previous 12 months. Headaches were categorized into specific diagnoses using a validated methodology.
Of 24,000 surveys, 18,514 were returned, and 13,451 (56%) provided complete data on ED use. Sociodemographic characteristics did not differ substantially between responders and nonresponders. Among the 13,451 responders, over the course of the previous year, 12,592 (94%) did not visit the ED at all, 415 (3%) visited the ED once, and 444 (3%) visited the ED more than once. Patients with severe episodic tension-type headache were less likely to use the ED than patients with severe episodic migraine (OR 0.4 [95% CI: 0.3, 0.6]). Frequent ED use was reported by 1% of the total sample or 19% (95% CI: 17%, 22%) of subjects who used the ED in the previous year, although frequent users accounted for 51% (95% CI: 49%, 53%) of all ED visits. Predictors of ED use included markers of disease severity, elevated depression scores, low socioeconomic status, and a predilection for ED use for conditions other than headache.
Most individuals suffering severe headaches do not use the ED over the course of a single year. The majority of ED visits for severe headache are accounted for by a small subset of all ED users. Increasing disease severity and depression are the most readily addressable factors associated with ED use.
尽管头痛是急诊科常见的主诉，但从人群角度对急诊科在原发性头痛疾病管理中的作用进行评估的情况却很少见。我们确定了重度头痛患者使用急诊科的频率及其使用的危险因素。
作为美国偏头痛患病率与预防研究的一部分，一份经过验证的自填式问卷被邮寄给了24000名重度头痛患者，这些患者是从一个更大的样本中随机抽取的，该样本在社会人口统计学上具有美国人群的代表性。参与者被问及一系列关于头痛管理、医疗系统使用、社会人口学特征以及过去12个月内因头痛管理而就诊急诊科的次数等问题。与其他人的研究一致，“频繁”使用急诊科被定义为参与者报告在过去12个月内因头痛治疗而就诊急诊科4次或更多次。使用经过验证的方法将头痛分类为特定诊断。
在24000份调查问卷中，18514份被退回，13451份（56%）提供了关于急诊科使用的完整数据。应答者和未应答者的社会人口学特征没有实质性差异。在13451名应答者中，在过去一年中，12592名（94%）根本没有去过急诊科，415名（3%）去过急诊科一次，444名（3%）去过急诊科不止一次。重度发作性紧张型头痛患者比重度发作性偏头痛患者使用急诊科的可能性更小（比值比0.4[95%置信区间：0.3，0.6]）。总样本中有1%或上一年使用过急诊科的受试者中有19%（95%置信区间：17%，22%）报告频繁使用急诊科，尽管频繁使用者占所有急诊科就诊次数的51%（95%置信区间：49%，53%）。急诊科使用的预测因素包括疾病严重程度指标、抑郁评分升高、社会经济地位低以及除头痛外对其他疾病倾向于使用急诊科。
大多数重度头痛患者在一年中不会使用急诊科。所有急诊科使用者中的一小部分占了因重度头痛而就诊急诊科的大部分人次。疾病严重程度增加和抑郁是与急诊科使用相关的最容易解决的因素。
