背景:头痛是急诊科(ED)中常见的一种情况,许多试验都集中在改善对这些患者的护理。然而,最近的大规模有限,关于发病率的可靠数据,录取率,评估,并在ED设置中进行治疗。
方法:这是一项使用EpicCosmos国家数据库对2016年1月1日至2023年12月31日头痛的ED表现进行的横断面研究。包括所有具有头痛相关ICD-10编码的ED访问。结果包括ED访问总数的百分比,录取率,计算机断层扫描(CT)脑成像,腰椎穿刺(LP)性能,和药物管理。药物分类分析(NSAIDs,对乙酰氨基酚,多巴胺拮抗剂,苯海拉明,阿片类药物,静脉输液,咖啡因,和硫酸镁)。通过特定类型的多巴胺拮抗剂进行亚组分析。
结果:在188,482,644次ED遭遇中,6,007,090(3.2%)是由于头痛。其中,246,082(4.1%)被录取。近一半(46.6%)的患者接受了至少一次CT检查。随着时间的推移,无对比CT头颅的比率从38.2%增加到47.9%,而CT血管造影的比率从2.8%上升到10.2%。1.4%的患者接受了LP,随着时间的推移,比率从1.8%下降到1.1%。最常见的药物是NSAIDs(45.3%),其次是多巴胺拮抗剂(44.8%),苯海拉明(38.1%),对乙酰氨基酚(24.8%),阿片类药物(16.3%),硫酸镁(0.2%),咖啡因(0.1%)。50.8%的患者接受了静脉输液。阿片类药物的比率随着时间的推移而下降,而多巴胺拮抗剂,对乙酰氨基酚,静脉输液增加。
结论:头痛是ED表现的常见原因,约4%的患者入院。经常进行成像,随着时间的推移,没有造影的CT和CT血管造影率上升,而LP利率一直在下降。NSAIDs仍然是最常见的药物,随着时间的推移,阿片类药物下降,而非阿片类药物如多巴胺拮抗剂增加。这些发现有助于为卫生政策举措提供信息,如那些专注于放射学成像和循证药物管理。
BACKGROUND: Headaches are a common condition seen in the Emergency Department (ED), with numerous trials focused on improving care for these patients. However, there is limited recent large-scale, robust data available on the incidence, admission rates, evaluation, and treatment in the ED setting.
METHODS: This was a cross-sectional study of ED presentations for headache from 1/1/2016 to 12/31/2023 using the Epic Cosmos national database. All ED visits with headache-relevant ICD-10 coding were included. Outcomes included percentage of total ED visits, admission rates, computed tomography (CT) brain imaging, lumbar puncture (LP) performance, and medication administration. Medications were analyzed by class (NSAIDs, acetaminophen, dopamine antagonists, diphenhydramine, opioids, intravenous fluids, caffeine, and magnesium sulfate). Subgroup analyses were performed by specific types of dopamine antagonists.
RESULTS: Of 188,482,644 ED encounters, 6,007,090 (3.2%) were due to headache. Of these, 246,082 (4.1%) were admitted. Nearly half (46.6%) of patients received at least one CT. Rates of CT head without contrast increased from 38.2% to 47.9% over time, while rates of CT angiography rose from 2.8% to 10.2%. 1.4% of all patients received an LP, with rates decreasing from 1.8% to 1.1% over time. The most common medication was NSAIDs (45.3%), followed by dopamine antagonists (44.8%), diphenhydramine (38.1%), acetaminophen (24.8%), opioids (16.3%), magnesium sulfate (0.2%), and caffeine (0.1%). 50.8% of patients received intravenous fluids. Rates of opioids declined over time, while dopamine antagonists, acetaminophen, and intravenous fluid administration increased.
CONCLUSIONS: Headaches represent a common reason for ED presentation, with approximately 4% of patients being admitted. Imaging is frequently performed, with rises in CT without contrast and CT angiography rates over time, while LP rates have been declining. NSAIDs remain the most common medication given, with opioids declining over time while non-opioid agents such as dopamine antagonists have increased. These findings can help inform health policy initiatives, such as those focused on radiologic imaging and evidence-based medication administration.