Identification of High-Risk Patients in the Pediatric Emergency Department with Symptoms of Headache
1Division of Pediatric Emergency Medicine, Ankara City Hospital, Ankara, Turkey
DOI: 10.22514/sv.2020.16.0015 Vol.16,Issue 1,June 2020 pp.115-121
Published: 30 June 2020
Objective: It is vital to detect life-threatening conditions in patients presenting to the pediatric emergency department with symptoms of headache. In this study, we aimed to evaluate patients who presented to our pediatric emergency department with symptoms of headache, and to determine which findings deserved the most attention in the anamnesis and during physical examinations. Methods: Patients who presented to the pediatric emergency department with symptoms of headache between July 2018 and June 2019 in Ankara, Turkey, were evaluated, retrospectively. Results: During the study period, 743 patients were included in the study. The median (IQR) age was 160.0 (range, 20.0-192.0) months. The male and female distribution was 46.2% (n = 343) and 53.8% (n = 400), respectively. The most common cause of headache was upper respiratory tract infections (84.2%). Severe headache symptoms were present in 2.3% of the entire patient group. In 81.2% of the patients with severe headache, various pathologic neurologic findings such as diffuse headache, nocturnal awakenings, vomiting, visual disturbances, nystagmus, cranial nerve pathologies, weakness, altered mental status, speech difficulty, and meningismus were present. Seventy-nine (10.6%) patients underwent neurologic imaging, and 15 (19.0%) had pathologic findings. Conclusion: Our data support that the most common cause of headaches in the pediatric emergency department is upper respiratory tract infections. The co-existence of nocturnal awakenings and/or the presence of pathologic-neurologic findings are red flags for cases of severe headache.
Children, Headache, Pediatric emergency medicine
Funda Kurt,Halil İbrahim Yakut. Identification of High-Risk Patients in the Pediatric Emergency Department with Symptoms of Headache. Signa Vitae. 2020. 16(1);115-121.
 Rossi R, Versace A, Lauria B, et al. Headache in the pediatric emergency department: A 5-year retrospective study. Cephalalgia. 2018;38:1765-72.
 Conicella E, Raucci U, Vanacore N, et al. The child with headache in a pediatric emergency department. Headache. 2008;48:1005-11.
 Sheridan DC, Meckler GD, Spiro DM, et al. Diagnostic testing and treatment of pediatric headache in the emergency department. The Journal of pediatrics. 2013;163:1634-7.
 Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disor-ders, 3rd edition. Cephalalgia. 2018;38:1-211.
 Kan L, Nagelberg J, Maytal J. Headaches in a pediatric emergency de-partment: etiology, imaging, and treatment. Headache. 2000;40:25-9.
 Scagni P, Pagliero R. Headache in an Italian pediatric emergency department. J Headache Pain. 2008;9:83-7.
 Gandhi R, Lewis EC, Evans JW, et al. Investigating the necessity of computed tomographic scans in children with headaches: a retrospective review. Cjem. 2015;17:148-53.
 Hsiao HJ, Huang JL, Hsia SH, et al. Headache in the pediatric emergency service: a medical center experience. Pediatrics and neonatology. 2014;55:208-12.
 Lateef TM, Grewal M, McClintock W, et al. Headache in young children in the emergency department: use of computed tomography. Pediatrics. 2009;124:e12-7.
 Ward TN, Levin M, Phillips JM. Evaluation and management of headache in the emergency department. The Medical clinics of North America. 2001;85:971-85.
 Lewis DW, Scott D, Rendin V. Treatment of paediatric headache. Expert opinion on pharmacotherapy. 2002;3:1433-42.
 Glatstein M, Voliovitch Y, Orbach R, et al. Outpatient Management of Headache after Pediatric Emergency Department Visit: Are we Missing Anything? Headache. 2019;59:1530-6.
 Cain MR, Arkilo D, Linabery AM, et al. Emergency Department Use of Neuroimaging in Children and Adolescents Presenting with Headache. The Journal of pediatrics. 2018;201:196-201.
 Yu S, Liu R, Zhao G, et al. The prevalence and burden of primary headaches in China: a population-based door-to-door survey. Headache. 2012;52:582-91.
 Stovner L, Hagen K, Jensen R, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27:193-210.
 Lewis DW, Qureshi F. Acute headache in children and adolescents presenting to the emergency department. Headache. 2000;40:200-3.
 Caperell K, Pitetti R. Seasonal variation of presentation for headache in a pediatric emergency department. Pediatric emergency care. 2014;30:174-6.
 M S, Lamont AC, Alias NA, et al. Red flags in patients presenting with headache: clinical indications for neuroimaging. The British journal of radiology. 2003;76:532-5.
 Larson DB, Johnson LW, Schnell BM, et al. Rising use of CT in child visits to the emergency department in the United States, 1995-2008. Radiology. 2011;259:793-801.
 Scheinfeld MH, Moon JY, Fagan MJ, et al. MRI usage in a pediatric emergency department: an analysis of usage and usage trends over 5 years. Pediatric radiology. 2017;47:327-32.
 Lewis DW, Dorbad D. The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations. Headache. 2000;40:629-32.
 Lewis DW, Ashwal S, Dahl G, et al. Practice parameter: evaluation of children and adolescents with recurrent headaches: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002;59:490-8.
 Eapen A, Agarwal R, Thomas R, et al. Management of pediatric migraine in a tertiary care versus community based emergency department: an observational pilot study. Pediatric neurology. 2014;50:164-70.
 DeVries A, Young PC, Wall E, et al. CT scan utilization patterns in pediatric patients with recurrent headache. Pediatrics. 2013;132:e1-8.
 Broder J, Fordham LA, Warshauer DM. Increasing utilization of computed tomography in the pediatric emergency department, 2000-2006. Emergency radiology. 2007;14:227-32.
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