急诊头痛患者在急症医院的收治情况：他们为什么会发生这种情况，我们能做些什么？

Emergency department headache admissions in an acute care hospital:why do they occur and what can we do about it?

机构信息

Department of Emergency Medicine, Changi General Hospital, Singapore.

出版信息

Ann Acad Med Singap. 2009 Nov;38(11):1007-10.

PMID:19956825

Abstract

INTRODUCTION

Many patients present to the Emergency Department (ED) complaining of headache and a significant proportion of these visits would result in hospital admissions. This study analyses the demographics, presentation, work-up, reasons for admission, diagnoses and outcomes of patients admitted with the chief complaint of headache--to identify possible ways of reducing such admissions.

MATERIALS AND METHODS

A retrospective analysis was done of the electronic medical records/discharge summaries of all adult patients admitted during a 1-year period from January to December 2006 with the diagnosis of primary headaches or secondary headaches not related to trauma, intracranial infection, inflammation, mass lesion, raised intracranial pressure or a serious systemic illness from the ED of the National University Hospital of Singapore.

RESULTS

One thousand two hundred and seventy-six patients presented to the adult ED with primary headaches or secondary headaches not related to serious conditions in 2006. This represented 2% of the ED attendances in the period. Two hundred and twenty-three patients were admitted for various reasons--diagnostic uncertainty: 110 (49%), pain control: 73 (33%), social/patient request: 60 (27%) and others: 4 (2%). Sixty-six per cent of the patients had either computed tomography (CT) or magnetic resonance (MR) head imaging. Eighteen patients (8%) were eventually diagnosed with a "potentially serious" diagnosis (intracranial haemorrhage, brain metastasis, stroke, meningitis, cerebral inflammation, cysticercosis, cervical osteomyelitis, hydrocephalus, seizure and malignant hypertension).

CONCLUSION

Specific strategies addressing the various reasons for admission including physician training, use of evaluation protocols, imaging to exclude secondary pathology, a longer duration of treatment and evaluation in the ED, effective pain control and patient education may help reduce headache admissions.

摘要

简介

许多患者因头痛到急诊科就诊，其中很大一部分需要住院治疗。本研究分析了以头痛为主诉的住院患者的人口统计学、表现、检查、住院原因、诊断和结局，以确定可能减少此类住院的方法。

材料与方法

对 2006 年 1 月至 12 月期间，在新加坡国立大学医院急诊科以原发性头痛或与创伤、颅内感染、炎症、肿块、颅内压升高或严重全身性疾病无关的继发性头痛为主诉就诊并诊断为原发性头痛或继发性头痛（不包括创伤、颅内感染、炎症、肿块、颅内压升高或严重全身性疾病）的所有成年患者的电子病历/出院小结进行回顾性分析。

结果

2006 年，1276 名成年患者因原发性头痛或与严重疾病无关的继发性头痛到急诊科就诊，占同期就诊人数的 2%。223 名患者因各种原因住院，包括诊断不确定：110 例（49%），止痛：73 例（33%），社会/患者要求：60 例（27%）和其他：4 例（2%）。66%的患者行头颅 CT 或磁共振成像（MRI）检查。18 例（8%）患者最终诊断为“潜在严重”疾病（颅内出血、脑转移瘤、中风、脑膜炎、脑炎症、囊虫病、颈椎骨髓炎、脑积水、癫痫发作和恶性高血压）。