Wells Simon, Stiell Ian G, Vishnyakova Evgeniya, Lun Ronda, Nemnom Marie-Joe, Perry Jeffrey J
Department of Emergency Medicine, Clinical Epidemiology Unit, The Ottawa Hospital, F647, 1053 Carling Avenue, Box 685, Ottawa, ON, K1Y 4E9, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
CJEM. 2021 Nov;23(6):802-811. doi: 10.1007/s43678-021-00173-0. Epub 2021 Aug 14.
We sought to evaluate the factors associated with better outcomes for emergency department (ED) patients treated for primary headache.
This was a health records review of consecutive patients over a 3-month period presenting to two tertiary EDs and discharged with a diagnosis of primary headache. The primary outcome was the need for second round medications, defined as medications received > 1 h after the initial physician-ordered medications were administered. We performed multivariate logistic regression analysis to determine treatment factors associated with need for second round medications.
We included 553 patients, mean age was 42.2 years and 72.9% were females. The most common diagnoses were headache not otherwise specified (48.8%) and migraine (43%). Ketorolac IV (62.2%) and metoclopramide IV (70.2%) were the most frequently administered medications. 18% of patients met the primary outcome. Dopamine antagonists (OR 0.3 [95% CI 0.1-0.5]) and non-steroidal anti-inflammatory drugs (NSAIDs) (OR 0.5 [95% CI 0.3-0.8]) ordered with initial medications were associated with reduced need for second round medications. Intravenous fluid boluses ≥ 500 ml (OR 2.8 [95% CI: 1.5-5.2]) and non-dopamine antagonist antiemetics (OR 2.2 [95% CI 1.2-4.2]) were associated with increased need. Opioid use approached statistical significance for receiving second round medication (p = 0.06).
We determined that use of dopamine antagonists and NSAIDs were associated with a reduced need for second round medications in ED primary headache patients. Conversely, non-dopamine antagonist antiemetic medications and intravenous fluids were associated with a significantly increased need for second round medications. Careful choice of initial therapy may optimize management for these patients.
我们试图评估与急诊科（ED）原发性头痛患者更好预后相关的因素。
这是一项对连续3个月就诊于两家三级急诊科并诊断为原发性头痛后出院的患者的健康记录回顾。主要结局是是否需要第二轮用药，定义为在首次医生开具的药物给药后1小时以上才接受的药物。我们进行了多因素逻辑回归分析，以确定与第二轮用药需求相关的治疗因素。
我们纳入了553例患者，平均年龄为42.2岁，72.9%为女性。最常见的诊断是未另行特指的头痛（48.8%）和偏头痛（43%）。静脉注射酮咯酸（62.2%）和静脉注射甲氧氯普胺（70.2%）是最常用的药物。18%的患者达到主要结局。初始用药时开具多巴胺拮抗剂（比值比[OR]0.3[95%置信区间（CI）0.1 - 0.5]）和非甾体抗炎药（NSAIDs）（OR 0.5[95%CI 0.3 - 0.8]）与第二轮用药需求减少相关。静脉推注液体≥500毫升（OR 2.8[95%CI：1.5 - 5.2]）和非多巴胺拮抗剂止吐药（OR 2.2[95%CI 1.2 - 4.2]）与需求增加相关。使用阿片类药物接受第二轮用药接近统计学意义（p = 0.06）。
我们确定，在急诊科原发性头痛患者中，使用多巴胺拮抗剂和NSAIDs与第二轮用药需求减少相关。相反，非多巴胺拮抗剂止吐药和静脉输液与第二轮用药需求显著增加相关。谨慎选择初始治疗可能会优化这些患者的管理。
