School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Headache. 2022 Apr;62(4):512-521. doi: 10.1111/head.14293. Epub 2022 Apr 10.
This national postal survey aimed to examine Canadian emergency physicians' practice patterns with respect to drug treatment and perspectives on peripheral nerve blocks.
The treatment of primary headache disorders in the emergency department is variable.
We surveyed 500 emergency physicians listed in the Canadian Medical Directory according to a modified Dillman's method: an initial invitation was followed by up to four reminders to nonresponders. Physicians were asked questions regarding their frequency of medication administration and perspectives toward peripheral nerve blocks.
Of 500 mailed surveys, 468 were delivered and 179 physicians responded (response rate = 38.2%). The majority of physicians were men (92/144, 63.9%); 80.6% (116/144) had been in practice for greater than or equal to 10 years with 50.7% (75/148) in a community or district general teaching hospital. Commonly used pharmacotherapies for primary headaches were intravenous dopamine receptor antagonists (69%), co-administration of ketorolac and a dopamine receptor antagonist (54.2%), intravenous fluid boluses (54%), nonsteroidal anti-inflammatory drugs (NSAIDs) alone (53.5%), and acetaminophen (51.4%). Only 80 of 144 physicians (55.6%) reported previous experience with peripheral nerve blocks (95% confidence interval [CI] = 48%-65%). The majority (68/80, 85.0%) agreed peripheral nerve blocks are safe and 55.1% (43/78) agreed they are effective. The vast majority (118/140, 84.3%) would consider peripheral nerve blocks as a first-line treatment option given sufficient evidence from a future trial (95% CI = 78%-90%).
NSAIDs alone, as well as dopamine receptor antagonists with or without ketorolac are commonly used for primary headache in Canadian emergency departments. A large proportion of physicians have never used a peripheral nerve block in their practice; among those who have experience with peripheral nerve blocks, the majority find them safe and effective. The majority of respondents would consider peripheral nerve blocks as a first-line treatment option given sufficient evidence from a future trial.
本项全国性邮政调查旨在研究加拿大急诊医师在药物治疗方面的实践模式及对外周神经阻滞的看法。
急诊科原发性头痛疾病的治疗方法存在差异。
我们根据改良的 Dillman 法，对加拿大医疗名录中的 500 名急诊医师进行了调查：首先发出邀请，然后对未回复者发送最多四条提醒。医师们被问到有关其给药频率和对外周神经阻滞看法的问题。
在寄出的 500 份调查中，有 468 份送达，179 名医师做出了回应（回复率=38.2%）。大多数医师为男性（92/144，63.9%）；80.6%（116/144）的医师从业时间大于或等于 10 年，其中 50.7%（75/148）在社区或地区综合教学医院工作。原发性头痛的常用药物治疗方法包括静脉内多巴胺受体拮抗剂（69%）、酮咯酸和多巴胺受体拮抗剂联合应用（54.2%）、静脉补液（54%）、单独使用非甾体抗炎药（53.5%）和对乙酰氨基酚（51.4%）。仅有 144 名医师中的 80 名（55.6%）报告曾有外周神经阻滞的经验（95%置信区间[CI]：48%-65%）。大多数医师（68/80，85.0%）认为外周神经阻滞是安全的，55.1%（43/78）认为其有效。如果有来自未来试验的充分证据，绝大多数医师（118/140，84.3%）会考虑将外周神经阻滞作为一线治疗选择（95%CI：78%-90%）。
在加拿大急诊部门，单独使用非甾体抗炎药，以及联合使用多巴胺受体拮抗剂和/或酮咯酸，是治疗原发性头痛的常用方法。很大一部分医师在其实践中从未使用过外周神经阻滞；在有外周神经阻滞经验的医师中，大多数人认为其安全且有效。如果有来自未来试验的充分证据，大多数受访者会考虑将外周神经阻滞作为一线治疗选择。
