PP296 Patient Involvement In An Assessment Of The Management Of Sudden Onset Severe Headache Presenting To The Emergency Department

2021 ◽  
Vol 37 (S1) ◽  
pp. 33-33
Author(s):  
Ros Wade ◽  
Matthew Walton ◽  
Melissa Harden ◽  
Robert Hodgson ◽  
Alison Eastwood ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Lumbar Puncture ◽  
Patient Involvement ◽  
Primary Headache ◽  
Development Stage ◽  
Sudden Onset ◽  
Severe Headache ◽  
Advisory Group ◽  
Protocol Development

IntroductionSudden onset severe headache is usually caused by a primary headache disorder but may be secondary to a more serious problem, such as subarachnoid hemorrhage (SAH). Very few patients who present to hospital with headache have suffered a SAH, but early identification is important to improve patient outcomes. A systematic review was undertaken to assess the clinical effectiveness of different care pathways for the management of headache, suspicious for SAH, in the Emergency Department. Capturing the perspective of patients was an important part of the research.MethodsThe project team included a patient collaborator with experience of presenting to the Emergency Department with sudden onset severe headache. Three additional patients were recruited to our advisory group. The patient's perspective was collected at various points through the project including at team meetings, during protocol development and when interpreting the results of the systematic review and drawing conclusions.ResultsPatients were reassured by the very high diagnostic accuracy of computed tomography (CT) for detecting SAH. Patients and clinicians emphasized the importance of shared decision making about whether to undergo additional tests to rule out SAH, after a negative CT result. When lumbar puncture was necessary, patients expressed a preference to have it on an ambulatory basis; further research on the safety and acceptability of ambulatory lumbar puncture was recommended.ConclusionsPatient input at the protocol development stage helped researchers understand the patient experience and highlighted important outcomes for assessment. Patient involvement added context to the review findings and highlighted the preferences of patients regarding the management of headache.

PP297 Management Of Sudden Onset Severe Headache Presenting To The Emergency Department: A Systematic Review

2021 ◽  
Vol 37 (S1) ◽  
pp. 33-34
Author(s):  
Ros Wade ◽  
Matthew Walton ◽  
Melissa Harden ◽  
Robert Hodgson ◽  
Alison Eastwood ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Adverse Events ◽  
Diagnostic Accuracy ◽  
False Positive ◽  
Clinical Decision ◽  
Sudden Onset ◽  
Severe Headache ◽  
Sufficient Information ◽  
Headache Onset

IntroductionSudden onset severe headache is usually caused by a primary headache disorder but occasionally is secondary to a more serious problem, such as subarachnoid hemorrhage (SAH). Guidelines recommend non-contrast brain computed tomography (CT) followed by lumbar puncture (LP) to exclude SAH. However, guidelines pre-date the introduction of more sensitive modern CT scanners. A systematic review was undertaken to assess the clinical effectiveness of different care pathways for the management of headache in the Emergency Department.MethodsEighteen databases (including MEDLINE and Embase) were searched to February 2020. Studies were quality assessed using criteria relevant to the study design; most studies were assessed using the QUADAS-2 tool for diagnostic accuracy studies. Where sufficient information was reported, diagnostic accuracy data were extracted into 2 × 2 tables to calculate sensitivity, specificity, false-positive and false-negative rates. Where possible, hierarchical bivariate meta-analysis was used to synthesize results, otherwise studies were synthesized narratively.ResultsFifty-one studies were included in the review. Eight studies assessing the accuracy of the Ottawa SAH clinical decision rule were pooled; sensitivity was 99.5 percent, specificity was 23.7 percent. The high false positive rate suggests that 76.3 percent SAH-negative patients would undergo further investigation unnecessarily. Four studies assessing the accuracy of CT within six hours of headache onset were pooled; sensitivity was 98.7 percent, specificity was 100 percent. CT sensitivity beyond six hours was considerably lower (≤90%; 2 studies). Three studies assessing LP following negative CT were pooled; sensitivity was 100 percent, specificity was 95.2 percent. LP-related adverse events were reported in 5.3–9.5 percent of patients.ConclusionsThe evidence suggests that the Ottawa SAH Rule is not sufficiently accurate for ruling out SAH and does little to aid clinical decision making. Modern CT within six hours of headache onset (with images assessed by a neuroradiologist) is highly accurate, but sensitivity reduces considerably over time. The CT-LP pathway is highly sensitive for detecting SAH, although LP resulted in some false-positives and adverse events.

scholarly journals Bilateral Lower Extremity Paralysis in a Caucasian Male Presenting to the Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Yicheng K. Bao ◽  
Vishwanath C. Ganesan ◽  
Richard Rapp ◽  
Shunzhong S. Bao
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Lower Extremity ◽  
Lumbar Puncture ◽  
Emergency Physician ◽  
Sudden Onset ◽  
Periodic Paralysis ◽  
Thyrotoxic Periodic Paralysis ◽  
Bilateral Lower Extremity ◽  
Negative Results

Reported is a case of a 39-year-old Caucasian man who presented to the emergency department with sudden onset bilateral lower extremity paralysis after consuming a large amount of carbohydrates and alcohol. A CT, MRI, and lumbar puncture were performed with negative results; lab results showed hyperthyroidism and hypokalemia. The patient was diagnosed with thyrotoxic periodic paralysis. In a patient presenting with sudden onset paralysis and hypokalemia, the emergency physician should include thyrotoxic periodic paralysis in the differential diagnosis and focus on treating and working up the hypokalemia instead of the paralysis.

An Acute Severe Headache

2016 ◽  
Vol 15 (2) ◽  
pp. 104-106
Author(s):  
Adnan Azim ◽  
◽  
C Spake ◽  
T Raza ◽  
◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Sudden Onset ◽  
Severe Headache ◽  
Accurate Diagnosis ◽  
Headache Diagnosis ◽  
The Uk ◽  
Underlying Pathology

Severe headaches are a frequent presentation to the Emergency Department, accounting for around 1% of presentations. Of these, 13-16% will have a sinister underlying pathology but accurate diagnosis of headaches on the medical take remain difficult for non-specialists. A retrospective study from the UK found that, of those presenting to Emergency Department with sudden onset severe headaches, only 60% were given a specific headache diagnosis, with one third of these given their diagnoses despite an inadequate history.

Elderly patientsʼ experiences of care in the emergency department: a systematic review

2010 ◽  
Vol 8 (Supplement) ◽  
pp. 1-25
Author(s):  
Lim Siew Hoon ◽  
Sandra Mackey ◽  
He Hong-Gu
Keyword(s):  
Systematic Review ◽  
Emergency Department

scholarly journals Injuries and frequent use of emergency department services: a systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040272
Author(s):  
Catherine Laferté ◽  
Andréa Dépelteau ◽  
Catherine Hudon
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Cohort Studies ◽  
Eligibility Criteria ◽  
Geriatric Population ◽  
Physical Injuries ◽  
Frequent Use ◽  
Different Types ◽  
Ed Visits ◽  
Return Visits

ObjectiveTo review all studies having examined the association between patients with physical injuries and frequent emergency department (ED) attendance or return visits.DesignSystematic review.Data sourceMedline, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO databases were searched up to and including July 2019.Eligibility criteriaEnglish and French language publications reporting on frequent use of ED services (frequent attendance and return visits), evaluating injured patients and using regression analysis.Data extraction and synthesisTwo independent reviewers screened the search results, and assessed methodological quality using the Joanna Briggs Institute tool for prevalence studies. Results were collated and summarised using a narrative synthesis. A sensitivity analysis was performed to evaluate the repercussions of removing a study that did not meet the quality criteria.ResultsOf the 2184 studies yielded by this search, 1957 remained after the removal of duplicates. Seventy-eight studies underwent full-text screening leaving nine that met the eligibility criteria and were included in this study: five retrospective cohort studies; two prospective cohort studies; one cross-sectional study; and one case-control study. Different types of injuries were represented, including fractures, trauma and physical injuries related to falls, domestic violence or accidents. Sample sizes ranged from 200 to 1 259 809. Six studies included a geriatric population while three addressed a younger population. Of the four studies evaluating the relationship between injuries and frequent ED use, three reported an association. Additionally, of the five studies in which the dependent variable was return ED visits, three articles identified a positive association with injuries.ConclusionsPhysical injuries appear to be associated with frequent use of ED services (frequent ED attendance as well as return ED visits). Further research into factors including relevant youth-related covariates such as substance abuse and different types of traumas should be undertaken to bridge the gap in understanding this association.

scholarly journals Factors influencing emergency department observation time following anaphylaxis: a systematic review

CJEM ◽  
2021 ◽  
Author(s):  
David Simard ◽  
Vanessa Bouchard ◽  
Annie Plourde ◽  
Sébastien Lefebvre ◽  
Antoine Herman-Lemelin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Observation Time ◽  
Factors Influencing
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