Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.
Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy.
J Headache Pain. 2020 Mar 14;21(1):25. doi: 10.1186/s10194-020-01094-6.
Headache is one of the most common reason for medical consultation to emergency department (ED). The inappropriate use of ED for non-emergency conditions is a problem in terms of overcrowding of emergency facilities, unnecessary testing and treatment, increased medical costs, burden on medical service providers and weaker relationships between patient and primary care provider. The aim of this study was to analyze the different stages of ED management of headache to identify those deficiencies that can be overcome by a fast referral to a headache clinic.
The study is a retrospective analysis of the electronic medical records of patients discharged from an academic ED between January 1, 2015 and December 31, 2018 and referred to the tertiary level headache centre of the same hospital. We analyzed all aspects related to the permanence in ED and also assessed whether there was a match between the diagnosis made in ED and ours.
Among our sample of 244 patients, 76.2% were admitted as "green tag", 75% underwent a head computed tomography, 19.3% received a neurological consultation, 43% did not receive any pharmacological treatment and 62.7% still had headache at discharge. The length of stay in ED was associated with reporting the first aura ever (p = 0.014) and whether patients received consultations (p < 0.001). The concordance analysis shown a significant moderate agreement only for the diagnosis of migraine and only between triage and headache centre.
Most patients who went to ED complaining of headache received the same treatment regardless of their diagnosis and in many cases the headache had not yet resolved at the time of discharge. Given the many shortcomings in headache management in ED, rapid referral to the headache centre is of paramount importance to help the patient achieve a definiteve diagnosis and appropriate treatment.
头痛是患者前往急诊部（ED）就诊的最常见原因之一。由于急诊设施过度拥挤、不必要的检查和治疗、增加医疗费用、给医疗服务提供者带来负担以及患者与初级保健提供者之间的关系减弱等原因，将非紧急情况带到 ED 就诊是一个问题。本研究的目的是分析 ED 管理头痛的不同阶段，以确定那些可以通过快速转介至头痛诊所来克服的缺陷。
本研究是对 2015 年 1 月 1 日至 2018 年 12 月 31 日期间从一家学术 ED 出院并转至同一家医院的三级头痛中心的患者的电子病历进行的回顾性分析。我们分析了与 ED 滞留相关的所有方面，并评估了 ED 做出的诊断与我们的诊断之间是否存在匹配。
在我们的 244 名患者样本中，76.2%被收入“绿色通道”，75%接受了头部计算机断层扫描，19.3%接受了神经科会诊，43%未接受任何药物治疗，62.7%在出院时仍有头痛。ED 滞留时间与首次出现先兆（p=0.014）和患者是否接受会诊（p<0.001）有关。一致性分析仅显示中度一致，仅适用于偏头痛的诊断，且仅在分诊和头痛中心之间。
大多数因头痛前往 ED 的患者接受了相同的治疗，无论其诊断如何，而且在许多情况下，在出院时头痛尚未缓解。鉴于 ED 中头痛管理存在许多缺陷，快速转介至头痛中心对于帮助患者获得明确的诊断和适当的治疗至关重要。
