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KMID : 0911820130140010001
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Korean Journal of Headache
2013 Volume.14 No. 1 p.1 ~ p.5
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Clinical Characteristics and Diagnoses for Pediatric Headache in the Emergency Department
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Hong Eun-Young
Choi Ka-Young
Kim Sung-Koo
Jung Ah-Young
Lee Kon-Hee
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Abstract
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Background: Many pediatric headache patients visit the emergency department (ED) due to an acute type of headache, and they are usually managed by going through several tests and treated after the initial diagnosis made by doctors working at ER. Therefore it is meaningful to study for the causes, usaul tests given, managements and the accuracy of the diagnosis made at the ED for these pediatric patients.
Methods: Of the 409 children and adolescents who visited our ED, from July 2006 to June 2008 with symtoms of a headache, 257 non-traumatic headache patients were enrolled. Residents working in the department of pediatrics usually managed these pediatric patients with headaches at the ED. Ninety-seven patients of them were followed-up at the pediatric headache outpatient clinic (PHOC) by a pediatric neurologist and finally a diagnosis was made according to the ICHD-II criteria until June 2010. To evaluate the accuracy of the initial diagnosis at the ED, they were compared with the final diagnosis, using the chi-square test, p-value of less than 0.05 meaning statistically significant.
Results: Of the 257 pediatric patients, boys were 155 (60.3%), girls were 102 (39.7%), respectively (boys to girls ratio was 1.5:1), mean age was 9.1±4.3 years. There were acute type of headaches in 238 patients (92.6%), acute recurrent type in 16 (6.2%), chronic in 3 (1.2%), respectively at the ED. 54 patients (21%) underwent tests (brain CT, MRI or CSF study). They were presumptively diagnosed as viral meningitis in 74 patients (28.8%) and upper respiratory tract infection in 43 (16.7%) as having the secondary headaches, migraine in 41 (16%) and tension-type headaches in 24 (9.3%) as having the primary headaches, and unclassified headaches in 36 (14.0%). As for the treatment of acute headaches, oral analgesics were administered in 103 patients (40.1%), injected drugs in 23 (8.9%), given oral medication and injected drugs in 51 (19.8%) respectively. But in 80 patients (31.1%) were not given any form of treatments. Among the 257 pediatric headache patients at the ED, 27 patients (10.5%) were hospitalized, and the other patients were recommended to revisit the PHOC. But only 70 patients (27.2%) were followed-up. For total of 97 patients who were either admitted or following-up, the
presumptive diagnosis at the ED and final diagnosis were compared (statistically significant difference p <0.05).
Conclusion: Many pediatric patients with headache visit the ED, the common causes of headaches are mostly due to acute upper respiratory tract infections or epidemic viral meningitis. But some of them are due to acute-recurrent or chronic type of headaches such as migraine or tension-type headache, which are diagnosed incorrectly at the busy ED. Therefore in our opinion, taking detailed histories and appropriate educations for headache to the ED doctors are considered.
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KEYWORD
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Headache, Emergency department, Diagnosis, Childhood, Adolescence
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