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The utility of clinical features in patients presenting with nontraumatic headache: an investigation of adult patients attending an emergency department.
Headache. 2006 Jun; 46(6):954-61.H

Abstract

OBJECTIVE

When patients present to an emergency department because of nontraumatic headache, they often present a diagnostic challenge. This study aimed to examine the utility of clinical features in detecting serious underlying causes of nontraumatic headache in adult patients presenting to an emergency department.

METHODS

A prospective observational study of alert adult patients presenting to 1 UK emergency department over a period of 14 months was conducted. Patients were excluded if their headache was related to trauma or they had been previously recruited into the study. A standardized data collection form was used to record details of the history and examination findings. Investigation and management were conducted according to the existing departmental protocols. Patients were followed up for 3 months following their initial presentation. Each factor in the history and examination was examined for its ability to predict a serious underlying cause of headache.

RESULTS

Five hundred and eighty-nine patients were included in the study with complete follow-up details obtained on 558 (94.7%) patients. Seventy-five (13.4%) patients were found to have a serious pathological cause of their headache. Four features were found to be significant independent predictors of serious pathology, these were age >50 years (likelihood ratio (LR) = 2.34), sudden onset, (LR = 1.74), any abnormality on neurological examination (LR = 3.56), and presentation due to associated features (LR = 2.27). Taken in combination, the presence of any 1 of the first 3 features has a sensitivity of 98.6% and specificity of 34.4% (Positive LR = 1.50, Negative LR = 0.04).

CONCLUSION

Three features, age greater than 50, sudden onset, and an abnormal neurological examination, are identified as significant independent predictors of serious pathology, which, in combination, can exclude the presence of such pathology in adult patients presenting with nontraumatic headache.

Authors+Show Affiliations

Locker TE
School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent St., Sheffield, S1 4DA UK.
Thompson C
No affiliation info available
Rylance J
No affiliation info available
Mason SM
No affiliation info available

MeSH

AdultAge FactorsBrain DiseasesEmergency Medical ServicesFollow-Up StudiesHeadacheHumansMedical History TakingMiddle AgedPredictive Value of TestsProspective StudiesSensitivity and Specificity

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16732841

Citation

Locker, Thomas E., et al. "The Utility of Clinical Features in Patients Presenting With Nontraumatic Headache: an Investigation of Adult Patients Attending an Emergency Department." Headache, vol. 46, no. 6, 2006, pp. 954-61.
Locker TE, Thompson C, Rylance J, et al. The utility of clinical features in patients presenting with nontraumatic headache: an investigation of adult patients attending an emergency department. Headache. 2006;46(6):954-61.
Locker, T. E., Thompson, C., Rylance, J., & Mason, S. M. (2006). The utility of clinical features in patients presenting with nontraumatic headache: an investigation of adult patients attending an emergency department. Headache, 46(6), 954-61.
Locker TE, et al. The Utility of Clinical Features in Patients Presenting With Nontraumatic Headache: an Investigation of Adult Patients Attending an Emergency Department. Headache. 2006;46(6):954-61. PubMed PMID: 16732841.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The utility of clinical features in patients presenting with nontraumatic headache: an investigation of adult patients attending an emergency department. AU - Locker,Thomas E, AU - Thompson,Catriona, AU - Rylance,Jamie, AU - Mason,Suzanne M, PY - 2006/5/31/pubmed PY - 2006/8/5/medline PY - 2006/5/31/entrez SP - 954 EP - 61 JF - Headache JO - Headache VL - 46 IS - 6 N2 - OBJECTIVE: When patients present to an emergency department because of nontraumatic headache, they often present a diagnostic challenge. This study aimed to examine the utility of clinical features in detecting serious underlying causes of nontraumatic headache in adult patients presenting to an emergency department. METHODS: A prospective observational study of alert adult patients presenting to 1 UK emergency department over a period of 14 months was conducted. Patients were excluded if their headache was related to trauma or they had been previously recruited into the study. A standardized data collection form was used to record details of the history and examination findings. Investigation and management were conducted according to the existing departmental protocols. Patients were followed up for 3 months following their initial presentation. Each factor in the history and examination was examined for its ability to predict a serious underlying cause of headache. RESULTS: Five hundred and eighty-nine patients were included in the study with complete follow-up details obtained on 558 (94.7%) patients. Seventy-five (13.4%) patients were found to have a serious pathological cause of their headache. Four features were found to be significant independent predictors of serious pathology, these were age >50 years (likelihood ratio (LR) = 2.34), sudden onset, (LR = 1.74), any abnormality on neurological examination (LR = 3.56), and presentation due to associated features (LR = 2.27). Taken in combination, the presence of any 1 of the first 3 features has a sensitivity of 98.6% and specificity of 34.4% (Positive LR = 1.50, Negative LR = 0.04). CONCLUSION: Three features, age greater than 50, sudden onset, and an abnormal neurological examination, are identified as significant independent predictors of serious pathology, which, in combination, can exclude the presence of such pathology in adult patients presenting with nontraumatic headache. SN - 0017-8748 UR - https://www.unboundmedicine.com/medline/citation/16732841/The_utility_of_clinical_features_in_patients_presenting_with_nontraumatic_headache:_an_investigation_of_adult_patients_attending_an_emergency_department_ DB - PRIME DP - Unbound Medicine ER -