Phoenix Children's Hospital, Phoenix, AZ 85016, USA.
Headache. 2013 Mar;53(3):491-197. doi: 10.1111/head.12042. Epub 2013 Feb 13.
To compare outcomes of pediatric migraine patients treated in an emergency department (ED) before and after implementation of a standardized combination intravenous therapy regimen aimed toward improving and standardizing abortive migraine therapy.
In a pediatric ED, migraines represent 8-18% of all headache visits. Despite this large number, no standard treatment for acute migraine therapy currently exists.
The study utilized a retrospective chart review of patients seeking acute migraine treatment at a tertiary care, pediatric ED from August 2006 to March 2010. Inclusion criteria were pediatric migraine patients as defined by International Headache Society guidelines. The comparison population received various migraine therapies based on attending practice preference. After October 2008, patients received standardized intravenous combination therapy involving a normal saline fluid bolus, ketorolac, prochlorperazine, and diphenhydramine. Occasionally, metoclopramide was substituted during prochlorperazine shortages. Reduction in headache pain score was the primary outcome. Secondary outcome measures included length of ED stay, hospital admission rate, and ED readmission rate within 48 hours.
The study yielded 87 patients who received standardized combination therapy and 165 comparison patients. No significant difference in patient characteristics existed when evaluating patient demographics, outpatient medication use, and initial headache pain score. When compared with the non-standardized therapy population, the combination therapy patients revealed significant reductions in pain score (decrease of 5.3 vs. 6.9, difference -1.6, 95% confidence interval -2.2 to -0.8, P < .001), length of ED stay (5.3 vs. 4.4 hours, difference 0.9, 95% confidence interval 0.2-1.6, P = .008), and hospital admission rate (32% vs. 3%, P < .001) without changes in ED return rate (7% vs. 2%, P = .148).
Standardized combination therapy is effective for acute pediatric migraine therapy in the ED by significantly reducing headache pain scores, length of ED stay, and hospital admission rates.
比较在实施旨在改善和规范偏头痛治疗的标准化联合静脉治疗方案前后，在急诊科（ED）接受治疗的儿科偏头痛患者的结局。
在儿科 ED，偏头痛占所有头痛就诊的 8-18%。尽管数量如此之多，但目前尚无急性偏头痛治疗的标准治疗方法。
该研究采用回顾性病历审查的方法，对 2006 年 8 月至 2010 年 3 月在三级护理儿科 ED 就诊的急性偏头痛患者进行研究。纳入标准为符合国际头痛协会指南定义的儿科偏头痛患者。比较人群根据主治医生的治疗偏好接受各种偏头痛治疗。2008 年 10 月后，患者接受标准化静脉联合治疗，包括生理盐水液滴注、酮咯酸、丙氯拉嗪和苯海拉明。在丙氯拉嗪短缺时，偶尔会用甲氧氯普胺替代。头痛疼痛评分的降低是主要结局。次要结局指标包括急诊停留时间、住院率和 48 小时内的急诊再入院率。
该研究纳入了 87 名接受标准化联合治疗的患者和 165 名比较患者。在评估患者人口统计学特征、门诊用药和初始头痛疼痛评分时，两组患者无显著差异。与非标准化治疗人群相比，联合治疗组患者的疼痛评分显著降低（降低 5.3 分 vs. 6.9 分，差值-1.6，95%置信区间-2.2 至-0.8，P<0.001），急诊停留时间缩短（5.3 小时 vs. 4.4 小时，差值 0.9，95%置信区间 0.2-1.6，P=0.008），住院率降低（32% vs. 3%，P<0.001），但急诊再入院率无变化（7% vs. 2%，P=0.148）。
标准化联合治疗通过显著降低头痛疼痛评分、急诊停留时间和住院率，对急诊儿科偏头痛治疗有效。
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