학술논문
Stratification of risk for emergent intracranial abnormalities in children with headaches: a Pediatric Emergency Care Applied Research Network (PECARN) study protocol.
Document Type
article
Author
Tsze, Daniel; Kuppermann, Nathan; Casper, T; Barney, Bradley; Richer, Lawrence; Liberman, Danica; Okada, Pamela; Morris, Claudia; Myers, Sage; Soung, Jane; Mistry, Rakesh; Babcock, Lynn; Spencer, Sandra; Johnson, Michael; Klein, Eileen; Quayle, Kimberly; Steele, Dale; Cruz, Andrea; Rogers, Alexander; Thomas, Danny; Grupp-Phelan, Jacqueline; Johnson, Tiffani; Dayan, Peter
Source
BMJ Open. 13(11)
Subject
Language
Abstract
INTRODUCTION: Headache is a common chief complaint of children presenting to emergency departments (EDs). Approximately 0.5%-1% will have emergent intracranial abnormalities (EIAs) such as brain tumours or strokes. However, more than one-third undergo emergent neuroimaging in the ED, resulting in a large number of children unnecessarily exposed to radiation. The overuse of neuroimaging in children with headaches in the ED is driven by clinician concern for life-threatening EIAs and lack of clarity regarding which clinical characteristics accurately identify children with EIAs. The study objective is to derive and internally validate a stratification model that accurately identifies the risk of EIA in children with headaches based on clinically sensible and reliable variables. METHODS AND ANALYSIS: Prospective cohort study of 28 000 children with headaches presenting to any of 18 EDs in the Pediatric Emergency Care Applied Research Network (PECARN). We include children aged 2-17 years with a chief complaint of headache. We exclude children with a clear non-intracranial alternative diagnosis, fever, neuroimaging within previous year, neurological or developmental condition such that patient history or physical examination may be unreliable, Glasgow Coma Scale score