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An international study of emergency physicians' practice for acute headache management and the need for a clinical decision rule

Published online by Cambridge University Press:  21 May 2015

Jeffrey J. Perry ,
Debra Eagles ,
Catherine M. Clement ,
Jamie Brehaut ,
Anne-Maree Kelly ,
Suzanne Mason  and
Ian G. Stiell
Jeffrey J. Perry*
Affiliation:
Department of Emergency Medicine, Ottawa Health Research Institute, University of Ottawa, Ottawa, Ont.
Debra Eagles
Affiliation:
Department of Emergency Medicine, Ottawa Health Research Institute, University of Ottawa, Ottawa, Ont.
Catherine M. Clement
Affiliation:
Department of Clinical Epidemiology Program, Ottawa Health Research Institute, University of Ottawa, Ottawa, Ont.
Jamie Brehaut
Affiliation:
Department of Epidemiology and Community Medicine, Ottawa Health Research Institute,University of Ottawa, Ottawa, Ont.
Anne-Maree Kelly
Affiliation:
Joseph Epstein Centre for Emergency Medicine Research, Western Health, Australia
Suzanne Mason
Affiliation:
Department of Emergency Medicine, University of Sheffield, UK
Ian G. Stiell
Affiliation:
Department of Emergency Medicine, Ottawa Health Research Institute, University of Ottawa, Ottawa, Ont.
*
Clinical Epidemiology Unit, F6, Ottawa Health Research Institute, The Ottawa Hospital, Civic Campus, 1053 Carling Ave., Ottawa ON K1Y 4E9; [email protected]

Abstract

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Objective:

Patients with acute headache often undergo computed tomography (CT) followed by a lumbar puncture to rule out subarachnoid hemorrhage. Our international study examined current practice, the perceived need for a clinical decision rule for acute headache and the required sensitivity for such a rule.

Methods:

We approached 2100 emergency physicians from 4 countries (Australia, Canada, the United Kingdom and the United States) to participate in our survey by sampling the membership of their emergency associations. We used a modified Dillman technique with 3–5 notifications and a prenotification letter employing a combination of electronic mail and postal mail. Physicians were questioned about neurologically intact patients who presented with headache. Analysis included both descriptive statistics for the entire sample and stratification by country.

Results:

The total response rate was 54.7% (1149/2100). Respondents were primarily male (75.5%), with a mean age of 42.5 years and a mean 12.3 years of emergency department (ED) experience. Of the physicians who responded, 49.5% thought all acute headache patients should be investigated with CT and 57.4% felt CT should always be followed by lumbar puncture. Of the respondents, 95.7% reported they would consider using a clinical decision rule for patients with acute headache to rule out subarachnoid hemorrhage. Respondents deemed the median sensitivity required by such a rule to be 99% (interquartile range 98%–99%). Approximately 1 in 5 physicians suggested that 100% sensitivity was required.

Conclusion:

Emergency physicians report that they would welcome a clinical decision rule for headache that would determine which patients require costly or invasive tests to rule out subarachnoid hemorrhage. The required sensitivity of such a rule was realistic. These results will inform and inspire the development of clinical decision rules for acute headache in the ED.

Keywords

clinical decision rulessubarachnoid hemorrhageheadacheemergency departmentlumbar puncturecomputed tomography
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 6 , November 2009 , pp. 516 - 522
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

References

REFERENCES

1.Ramirez-Lassepas, M, Espinosa, CE, Cicero, JJ, et al. Predictors of intracranial pathologic findings in patients who seek emergency care because of headache. Arch Neurol 1997;54:1506–9.Google Scholar
2.Latchaw, RE, Silva, P, Falcone, SF. The role of CT following aneurysmal rupture. Neuroimaging Clin NAm 1997;7:693–708.Google Scholar
3.Laupacis, A, Sekar, N, Stiell, IG. Clinical prediction rules: a review and suggested modifications of methodological standards. JAMA 1997;277:488–94.Google Scholar
4.Stiell, IG, Wells, GA. Methodologic standards for the development of clinical decision rules in emergency medicine. Ann Emerg Med 1999;33:437–47.CrossRefGoogle ScholarPubMed
5.Wasson, JH, Sox, HC, Neff, RK, et al. Clinical prediction rules: applications and methodological standards. N Engl J Med 1985;313:793–9.Google Scholar
6.Dillman, D. Mail and internet surveys: the tailored design method. New York (NY): Wiley; 2000.Google Scholar
7.Denny, CJ, Schull, MJ. Headache and facial pain. In Tintinalli, JE, Kelen, GD, Stapczynski, JS, editors. Emergency medicine: a comprehensive study guide.Whitby (ON): McGraw-Hill; 2004 p. 1375–82.Google Scholar
8.Perry, JJ, Sivilotti, ML, Stiell, IG, et al. Should spectropho-tometry be used to identify xanthochromia in the cerebrospinal fluid of alert patients suspected of having subarachnoid hemorrhage? Stroke 2006;37:2467–72.Google Scholar
9.Perry, JJ, Stiell, IG, Wells, GA,et al. Historical cohort study “use and yield of investigations for alert patients with possible subarachnoid hemorrhage.” CJEM 2002;4:333–7.Google Scholar
10.Cummings, SM, Savitz, LA, Konrad, TR. Reported response rates to mailed physician questionnaires. Health Serv Res 2001;35:1347–55.Google Scholar
11.Asch, DA, Jedrziewski, MKQ, Christakis, NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol 1997;10:1129–36.Google Scholar