Ramirez-Lassepas M, Espinosa C E, Cicero J J, Johnston K L, Cipolle R J, Barber D L
Department of Neurology, St Paul-Ramsey Medical Center, St Paul, Minn.
Arch Neurol. 1997 Dec;54(12):1506-9. doi: 10.1001/archneur.1997.00550240058013.
Clinical criteria to select patients with headache in whom structural diagnostic studies (computed tomography) have a high yield disclosing intracranial pathologic findings, independent of abnormal findings on neurologic examination, have not been defined.
To determine which clinical characteristics predict the presence of intracranial pathologic findings, independently of neurologic examination, in patients with headache.
Case-control, consecutive sample.
Major metropolitan trauma center emergency department.
Hospital records of 139 hospitalized and 329 randomly selected patients from 1720 nonhospitalized adult patients, consecutively evaluated for headache in the emergency department, were reviewed. Demographic data, clinical characteristics of the headache, results of neurologic and physical examinations, and diagnostic radiologic and laboratory results were correlated with final diagnosis and outcome at 6 months after emergency department visit.
Nonparametric statistical analysis.
Intracranial pathologic findings were found in 18 (3.8%) of 468 patients. Acute onset and occipitonuchal location of headache, presence of associated symptoms, and patient age of 55 years or older were significantly associated with the finding of intracranial pathology, independently of the findings from neurologic examination. Abnormal findings on neurologic examination alone, whether focal or nonfocal, had a highly significant association and a positive predictive value for intracranial pathology of 39%.
Abnormal results from neurologic examination are the best clinical parameters to predict structural intracranial pathology; however, in patients 55 years or older with headache of acute onset located in the occipitonuchal region that has associated symptoms, computed tomographic scan of the head is justified as part of their clinical evaluation independently of the findings of the neurologic examination.
尚未确定用于选择头痛患者进行结构诊断研究（计算机断层扫描）的临床标准，这些研究能高概率揭示颅内病理结果，且与神经系统检查的异常结果无关。
确定在头痛患者中，哪些临床特征能独立于神经系统检查预测颅内病理结果的存在。
病例对照连续样本。
主要大都市创伤中心急诊科。
回顾了1720名非住院成年患者中139名住院患者和329名随机选择患者的医院记录，这些患者在急诊科连续接受头痛评估。人口统计学数据、头痛的临床特征、神经系统和体格检查结果以及诊断性放射学和实验室结果与急诊科就诊后6个月的最终诊断和结局相关。
非参数统计分析。
468名患者中有18名（3.8%）发现颅内病理结果。头痛的急性发作和枕颈部位置、相关症状的存在以及55岁及以上的患者年龄与颅内病理结果的发现显著相关，且独立于神经系统检查结果。仅神经系统检查的异常结果，无论是局灶性还是非局灶性，与颅内病理有高度显著关联，阳性预测值为39%。
神经系统检查的异常结果是预测颅内结构病变的最佳临床参数；然而，对于55岁及以上、头痛急性发作且位于枕颈部区域并伴有相关症状的患者，无论神经系统检查结果如何，头部计算机断层扫描作为其临床评估的一部分是合理的。
