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Attitudes and judgment of emergency physicians in the management of patients with acute headache.
Acad Emerg Med. 2005 Jan; 12(1):33-7.AE

Abstract

OBJECTIVES

There is little evidence guiding physicians in the evaluation of acute headache to rule out nontraumatic subarachnoid hemorrhage (SAH). The authors assessed emergency physicians in: 1) their pretest accuracy for predicting SAH, 2) their comfort with not ordering either head computed tomography (CT) or lumbar puncture (LP) in patients with acute headache, and 3) their comfort with not ordering head CT before performing LP in patients with acute headache.

METHODS

This two-and-a-half-year prospective cohort study was conducted in three tertiary care university emergency departments with 51 emergency physicians. Consecutive patients more than 15 years of age with a nontraumatic, acute headache (onset to peak headache less than one hour) and normal results on neurologic examination were enrolled. Patients known to have cerebrospinal fluid shunt, aneurysm, or brain neoplasm, and patients with recurrent headaches of the same intensity/character as their current headache were excluded. Physicians recorded their pretest probability for SAH and their comfort with performing either no tests or an LP without first obtaining head CT.

RESULTS

The authors enrolled 747 patients (mean age 42.8 years; 60.1% female; 77.0% their worst headache; 83.4% had CT and/or LP), including 50 (6.7%) with SAHs. Physicians reported being "uncomfortable" or "very uncomfortable" with performing no test in 75.4% of cases and being "uncomfortable" or "very uncomfortable" with performing LP without CT in 49.6% of cases. The area under the receiver operating characteristic (ROC) curve for SAH was 0.85 (95% CI = 0.80 to 0.91).

CONCLUSIONS

Physicians were able to moderately discriminate SAH from other causes of headache before diagnostic testing.

Authors+Show Affiliations

Perry JJ
Department of Emergency Medicine, University of Ottawa, Ontario, Canada. jperry@ohri.ca
Stiell IG
No affiliation info available
Wells GA
No affiliation info available
Mortensen M
No affiliation info available
Lesiuk H
No affiliation info available
Sivilotti M
No affiliation info available
Kapur A
No affiliation info available

MeSH

Acute DiseaseAdultAttitude of Health PersonnelClinical CompetenceCohort StudiesDiagnosis, DifferentialEmergency Medical ServicesEmergency Service, HospitalFemaleHeadacheHumansMaleMiddle AgedNeurologic ExaminationPain MeasurementPractice Patterns, Physicians'Prospective StudiesRisk AssessmentSensitivity and SpecificitySeverity of Illness IndexSpinal PunctureSubarachnoid HemorrhageTomography, X-Ray Computed

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15635135

Citation

Perry, Jeffrey J., et al. "Attitudes and Judgment of Emergency Physicians in the Management of Patients With Acute Headache." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 12, no. 1, 2005, pp. 33-7.
Perry JJ, Stiell IG, Wells GA, et al. Attitudes and judgment of emergency physicians in the management of patients with acute headache. Acad Emerg Med. 2005;12(1):33-7.
Perry, J. J., Stiell, I. G., Wells, G. A., Mortensen, M., Lesiuk, H., Sivilotti, M., & Kapur, A. (2005). Attitudes and judgment of emergency physicians in the management of patients with acute headache. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 12(1), 33-7.
Perry JJ, et al. Attitudes and Judgment of Emergency Physicians in the Management of Patients With Acute Headache. Acad Emerg Med. 2005;12(1):33-7. PubMed PMID: 15635135.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Attitudes and judgment of emergency physicians in the management of patients with acute headache. AU - Perry,Jeffrey J, AU - Stiell,Ian G, AU - Wells,George A, AU - Mortensen,Melodie, AU - Lesiuk,Howard, AU - Sivilotti,Marco, AU - Kapur,Atul, PY - 2005/1/7/pubmed PY - 2005/4/7/medline PY - 2005/1/7/entrez SP - 33 EP - 7 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 12 IS - 1 N2 - OBJECTIVES: There is little evidence guiding physicians in the evaluation of acute headache to rule out nontraumatic subarachnoid hemorrhage (SAH). The authors assessed emergency physicians in: 1) their pretest accuracy for predicting SAH, 2) their comfort with not ordering either head computed tomography (CT) or lumbar puncture (LP) in patients with acute headache, and 3) their comfort with not ordering head CT before performing LP in patients with acute headache. METHODS: This two-and-a-half-year prospective cohort study was conducted in three tertiary care university emergency departments with 51 emergency physicians. Consecutive patients more than 15 years of age with a nontraumatic, acute headache (onset to peak headache less than one hour) and normal results on neurologic examination were enrolled. Patients known to have cerebrospinal fluid shunt, aneurysm, or brain neoplasm, and patients with recurrent headaches of the same intensity/character as their current headache were excluded. Physicians recorded their pretest probability for SAH and their comfort with performing either no tests or an LP without first obtaining head CT. RESULTS: The authors enrolled 747 patients (mean age 42.8 years; 60.1% female; 77.0% their worst headache; 83.4% had CT and/or LP), including 50 (6.7%) with SAHs. Physicians reported being "uncomfortable" or "very uncomfortable" with performing no test in 75.4% of cases and being "uncomfortable" or "very uncomfortable" with performing LP without CT in 49.6% of cases. The area under the receiver operating characteristic (ROC) curve for SAH was 0.85 (95% CI = 0.80 to 0.91). CONCLUSIONS: Physicians were able to moderately discriminate SAH from other causes of headache before diagnostic testing. SN - 1069-6563 UR - https://www.unboundmedicine.com/medline/citation/15635135/Attitudes_and_judgment_of_emergency_physicians_in_the_management_of_patients_with_acute_headache_ DB - PRIME DP - Unbound Medicine ER -