Abstract
BackgroundHeadache is one of the most common reason for medical consultation to emergency department (ED). The inappropriate use of ED for non-emergency conditions is a problem in terms of overcrowding of emergency facilities, unnecessary testing and treatment, increased medical costs, burden on medical service providers and weaker relationships between patient and primary care provider. The aim of this study was to analyze the different stages of ED management of headache to identify those deficiencies that can be overcome by a fast referral to a headache clinic.MethodsThe study is a retrospective analysis of the electronic medical records of patients discharged from an academic ED between January 1, 2015 and December 31, 2018 and referred to the tertiary level headache centre of the same hospital. We analyzed all aspects related to the permanence in ED and also assessed whether there was a match between the diagnosis made in ED and ours.ResultsAmong our sample of 244 patients, 76.2% were admitted as “green tag”, 75% underwent a head computed tomography, 19.3% received a neurological consultation, 43% did not receive any pharmacological treatment and 62.7% still had headache at discharge. The length of stay in ED was associated with reporting the first aura ever (p = 0.014) and whether patients received consultations (p < 0.001). The concordance analysis shown a significant moderate agreement only for the diagnosis of migraine and only between triage and headache centre.ConclusionsMost patients who went to ED complaining of headache received the same treatment regardless of their diagnosis and in many cases the headache had not yet resolved at the time of discharge. Given the many shortcomings in headache management in ED, rapid referral to the headache centre is of paramount importance to help the patient achieve a definiteve diagnosis and appropriate treatment.
Highlights
Headache is one of the most common symptoms and an important reason for medical consultation and presentation to emergency departments (EDs)
Studies evaluating this phenomenon have found that the inability to take time off from school or work during the day and the ease of use of emergency care without the need for an appointment are cited as a reason for their consultation by a significant percentage of patients, suggesting that inappropriate use of ED could be a matter of personal convenience [14, 15]
The appearance of a migraine aura was the main reason for consulting for ED for 40 (16.4) patients and for 16 (40%) of them it was the first aura of their lives
Summary
Headache is one of the most common symptoms and an important reason for medical consultation and presentation to emergency departments (EDs). Inappropriate use of ED for non-emergency conditions is a problem in terms of overcrowding of emergency facilities, unnecessary testing and treatment, increased medical costs, burden on medical service providers and weaker relationships between patient and primary care provider Studies evaluating this phenomenon have found that the inability to take time off from school or work during the day and the ease of use of emergency care without the need for an appointment are cited as a reason for their consultation by a significant percentage of patients, suggesting that inappropriate use of ED could be a matter of personal convenience [14, 15]. The inappropriate use of ED for non-emergency conditions is a problem in terms of overcrowding of emergency facilities, unnecessary testing and treatment, increased medical costs, burden on medical service providers and weaker relationships between patient and primary care provider. The aim of this study was to analyze the different stages of ED management of headache to identify those deficiencies that can be overcome by a fast referral to a headache clinic
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