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Predictive Factors and Clinical Prediction Score for Serious Intracranial Causes in Acute Nontraumatic Headache at an Emergency Department.
Emerg Med Int 2019; 2019:4267825EM

Abstract

Purpose

The objectives of this study were to investigate the predictive factors and develop a clinical prediction score to identify serious intracranial causes in acute nontraumatic headache (NTH).

Methods

A retrospective chart review study was conducted from 2013 to 2018 in acute NTH patients who visited the emergency department. The patients were divided into serious intracranial headache and nonserious intracranial headache groups. The two groups were compared in regard to the baseline characteristics, clinical presentation, physical examination, investigation, and diagnosis. The significant factors to predict a serious intracranial cause were examined using a multivariate logistic regression model. The coefficients from the multivariate logistic regression were used to plot the receiver operating characteristic curve to develop a clinical prediction score.

Results

From 2,372 patients, 454 met the inclusion criteria. Of the 454 patients with acute NTH, 88 (19.4%) patients were serious intracranial cause. The seven significant factors that predicted serious intracranial cause were abrupt onset (odds ratio (OR) 7.96, 95% confidence interval (CI) 2.77‒22.91), awakening pain (OR 3.14, 95% CI 4.15-6.82), duration of headache >1 week (OR 10.59, 95% CI 2.9-38.7), fever (OR 6.01, 95% CI 2.07-17.46), worst headache ever (OR 12.95, 95% CI 5.69-29.45), alteration of consciousness (OR 13.55, 95% CI 2.07‒88.88), and localizing neurological deficit (OR 5.28, 95% CI 1.6‒17.46). A score ≥3 out of 10 points of the clinical prediction score was likely to identify a serious intracranial cause of acute NTH with a sensitivity and specificity of 87.50% (95% CI 78.73-93.59%) and 87.70% (95% CI 83.90-90.89%), respectively. The area under the curve was 0.933.

Conclusion

Abrupt onset, awakening pain, duration of headache >1 week, fever, worst headache ever, alteration of consciousness, and localizing neurological deficit were the significant predictive factors for serious intracranial cause of acute NTH.

Authors+Show Affiliations

Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31885925

Citation

Tantarattanapong, Siriwimon, and Lalita Chalongkulasak. "Predictive Factors and Clinical Prediction Score for Serious Intracranial Causes in Acute Nontraumatic Headache at an Emergency Department." Emergency Medicine International, vol. 2019, 2019, p. 4267825.
Tantarattanapong S, Chalongkulasak L. Predictive Factors and Clinical Prediction Score for Serious Intracranial Causes in Acute Nontraumatic Headache at an Emergency Department. Emerg Med Int. 2019;2019:4267825.
Tantarattanapong, S., & Chalongkulasak, L. (2019). Predictive Factors and Clinical Prediction Score for Serious Intracranial Causes in Acute Nontraumatic Headache at an Emergency Department. Emergency Medicine International, 2019, p. 4267825. doi:10.1155/2019/4267825.
Tantarattanapong S, Chalongkulasak L. Predictive Factors and Clinical Prediction Score for Serious Intracranial Causes in Acute Nontraumatic Headache at an Emergency Department. Emerg Med Int. 2019;2019:4267825. PubMed PMID: 31885925.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictive Factors and Clinical Prediction Score for Serious Intracranial Causes in Acute Nontraumatic Headache at an Emergency Department. AU - Tantarattanapong,Siriwimon, AU - Chalongkulasak,Lalita, Y1 - 2019/10/31/ PY - 2019/06/02/received PY - 2019/09/05/revised PY - 2019/09/21/accepted PY - 2019/12/31/entrez PY - 2019/12/31/pubmed PY - 2019/12/31/medline SP - 4267825 EP - 4267825 JF - Emergency medicine international JO - Emerg Med Int VL - 2019 N2 - Purpose: The objectives of this study were to investigate the predictive factors and develop a clinical prediction score to identify serious intracranial causes in acute nontraumatic headache (NTH). Methods: A retrospective chart review study was conducted from 2013 to 2018 in acute NTH patients who visited the emergency department. The patients were divided into serious intracranial headache and nonserious intracranial headache groups. The two groups were compared in regard to the baseline characteristics, clinical presentation, physical examination, investigation, and diagnosis. The significant factors to predict a serious intracranial cause were examined using a multivariate logistic regression model. The coefficients from the multivariate logistic regression were used to plot the receiver operating characteristic curve to develop a clinical prediction score. Results: From 2,372 patients, 454 met the inclusion criteria. Of the 454 patients with acute NTH, 88 (19.4%) patients were serious intracranial cause. The seven significant factors that predicted serious intracranial cause were abrupt onset (odds ratio (OR) 7.96, 95% confidence interval (CI) 2.77‒22.91), awakening pain (OR 3.14, 95% CI 4.15-6.82), duration of headache >1 week (OR 10.59, 95% CI 2.9-38.7), fever (OR 6.01, 95% CI 2.07-17.46), worst headache ever (OR 12.95, 95% CI 5.69-29.45), alteration of consciousness (OR 13.55, 95% CI 2.07‒88.88), and localizing neurological deficit (OR 5.28, 95% CI 1.6‒17.46). A score ≥3 out of 10 points of the clinical prediction score was likely to identify a serious intracranial cause of acute NTH with a sensitivity and specificity of 87.50% (95% CI 78.73-93.59%) and 87.70% (95% CI 83.90-90.89%), respectively. The area under the curve was 0.933. Conclusion: Abrupt onset, awakening pain, duration of headache >1 week, fever, worst headache ever, alteration of consciousness, and localizing neurological deficit were the significant predictive factors for serious intracranial cause of acute NTH. SN - 2090-2840 UR - https://www.unboundmedicine.com/medline/citation/31885925/Predictive_Factors_and_Clinical_Prediction_Score_for_Serious_Intracranial_Causes_in_Acute_Nontraumatic_Headache_at_an_Emergency_Department L2 - https://dx.doi.org/10.1155/2019/4267825 DB - PRIME DP - Unbound Medicine ER -