Jones Christopher W, Gaughan John P, McLean Samuel A
Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA.
Cooper Research Institute, Cooper University Hospital, Camden, NJ, USA.
Am J Emerg Med. 2017 May;35(5):778-781. doi: 10.1016/j.ajem.2017.01.030. Epub 2017 Jan 15.
Headache is one of the most common reasons for patients to seek care in emergency departments. While the administration of intravenous fluids is frequently recommended for emergency department patients with migraine, the epidemiology of the use of this intervention is unknown.
To describe the epidemiology of intravenous fluid use in emergency department patients with headache.
This retrospective study utilized the 2011 US National Hospital Ambulatory Medical Survey, a multi-stage weighted survey providing nationally representative estimates of ED visits. Patients with chief complaints of non-traumatic headache or migraine headache were included. We determined the frequency of intravenous fluid administration among patients presenting with headache, and among specific subgroups including those with migraine headache.
There were 1251 sample cases representing 5,981,000 visits for a chief complaint of headache. Intravenous fluids were administered at 40% (95% CI 35-44%) of these visits. Among the 222 migraine cases, 47% (95% CI 39-56%) received fluids. Fluids were commonly administered regardless of pain severity, and fluid administration was not significantly associated with pain severity among patients diagnosed with migraine (p=0.39). After adjusting for patient characteristics, ED visit duration remained greater for patients receiving fluids than for those who did not among both patients with a headache complaint and among those with a diagnosis of migraine headache.
Despite a lack of efficacy data, patients treated in United States EDs for headache frequently receive IV fluids. Studies are needed to determine the efficacy of this basic treatment intervention.
头痛是患者前往急诊科就诊的最常见原因之一。虽然对于急诊科偏头痛患者，常建议给予静脉输液治疗，但这种干预措施的使用流行病学情况尚不清楚。
描述急诊科头痛患者静脉输液的使用流行病学情况。
这项回顾性研究利用了2011年美国国家医院门诊医疗调查，这是一项多阶段加权调查，提供全国具有代表性的急诊就诊估计数据。纳入以非创伤性头痛或偏头痛为主诉的患者。我们确定了头痛患者以及包括偏头痛患者在内的特定亚组中静脉输液的频率。
有1251个样本病例，代表了598.1万次以头痛为主诉的就诊。在这些就诊中，40%（95%可信区间35%-44%）的患者接受了静脉输液。在222例偏头痛病例中，47%（95%可信区间39%-56%）接受了输液。无论疼痛严重程度如何，输液都很常见，并且在诊断为偏头痛的患者中，输液与疼痛严重程度无显著相关性（p=0.39）。在调整患者特征后，头痛患者和诊断为偏头痛的患者中，接受输液的患者急诊就诊时间仍比未接受输液的患者更长。
尽管缺乏疗效数据，但在美国急诊科接受头痛治疗的患者经常接受静脉输液。需要开展研究以确定这种基本治疗干预措施的疗效。
