Pediatric Emergency Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France; Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France.
Pediatric Emergency Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France.
J Pediatr. 2014 Aug;165(2):376-82. doi: 10.1016/j.jpeds.2014.04.053. Epub 2014 Jun 11.
To identify predictors of secondary headache in children consulting at the pediatric emergency department (ED) for headache with a focal neurologic deficit.
In this prospective cohort study, we enrolled children aged 6-18 years presenting to the ED of a tertiary care hospital with moderate to severe headache and focal neurologic deficit. Enrollment took place between March 2009 and February 2012. Children with a history of trauma, fever, or neurosurgical intervention were excluded from the study. The final diagnosis was made after 1 year of follow-up. Our primary aim was to identify any differences in the frequency of clinical signs between children with a final diagnosis of primary headache and those with a final diagnosis of secondary headache.
Of the 101 patients included in the study, 66% received a final diagnosis of primary headache (94% migraine with aura), and 34% received a final diagnosis of secondary headache (76.5% focal epilepsy). On multivariate analysis, children with bilateral localization of pain had a higher likelihood (aOR, 8.6; 95% CI, 3.2-23.2; P<.001) of having secondary headache.
Among children presenting to the ED with focal neurologic deficits, a bilateral headache location was associated with higher odds of having a secondary cause of headache. Additional longitudinal studies are needed to investigate whether our data can aid management in the ED setting.
确定在儿科急诊就诊的头痛伴有局灶性神经功能缺损的儿童中继发性头痛的预测因素。
在这项前瞻性队列研究中，我们招募了 6-18 岁的儿童，这些儿童因中度至重度头痛和局灶性神经功能缺损而到三级医院的急诊就诊。招募时间为 2009 年 3 月至 2012 年 2 月。有创伤史、发热或神经外科干预史的儿童被排除在研究之外。最终诊断是在 1 年的随访后做出的。我们的主要目的是确定最终诊断为原发性头痛的儿童与最终诊断为继发性头痛的儿童之间临床体征的频率是否存在差异。
在纳入研究的 101 名患者中，66%的患者最终诊断为原发性头痛（94%为有先兆的偏头痛），34%的患者最终诊断为继发性头痛（76.5%为局灶性癫痫）。在多变量分析中，疼痛双侧定位的儿童更有可能（优势比，8.6；95%置信区间，3.2-23.2；P<.001）患有继发性头痛。
在因局灶性神经功能缺损而就诊于急诊的儿童中，双侧头痛部位与继发性头痛的可能性更高相关。需要进一步的纵向研究来调查我们的数据是否可以帮助指导急诊管理。
