Triage bei Kopfschmerz in der Hausarztpraxis: Wann einweisen?

2019 ◽  
Vol 144 (10) ◽  
pp. 651-658
Author(s):  
Solveig Carmienke ◽  
Dagny Holle-Lee
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
General Practitioner ◽  
Hospital Care ◽  
Secondary Headache ◽  
Red Flags ◽  
Secondary Headaches ◽  
Specialist Treatment ◽  
Yellow Flags ◽  
Headache Patients

AbstractHeadache is one of patients’ most common reasons to consult their general practitioner and covers about 2 – 5 % of the consultations in primary care. Often, the general practitioner is the first to be contacted by patients with headache. Mostly, headaches are primary and only 2 % of the patients have secondary headaches. The distinction between primary and secondary headache is the most important step in the management of patients with headache in primary care. Therefore, this article shows important elements of anamnesis and examination of headache patients in primary care. Furthermore, this article focuses on identification of red flags and yellow flags in the consultation of patients with headache and suggests recommendations for referral to emergency department, hospital care or specialist treatment.

scholarly journals Red and orange flags for secondary headaches in clinical practice

Neurology ◽  
2018 ◽  
Vol 92 (3) ◽  
pp. 134-144 ◽  
Author(s):  
Thien Phu Do ◽  
Angelique Remmers ◽  
Henrik Winther Schytz ◽  
Christoph Schankin ◽  
Sarah E. Nelson ◽  
...  
Keyword(s):  
Headache Disorder ◽  
Abrupt Onset ◽  
Epidemiologic Studies ◽  
Secondary Headache ◽  
Red Flags ◽  
Secondary Headaches ◽  
Recent Onset ◽  
Systemic Symptoms ◽  
Atypical Presentations ◽  
Headache Patients

A minority of headache patients have a secondary headache disorder. The medical literature presents and promotes red flags to increase the likelihood of identifying a secondary etiology. In this review, we aim to discuss the incidence and prevalence of secondary headaches as well as the data on sensitivity, specificity, and predictive value of red flags for secondary headaches. We review the following red flags: (1) systemic symptoms including fever; (2) neoplasm history; (3) neurologic deficit (including decreased consciousness); (4) sudden or abrupt onset; (5) older age (onset after 65 years); (6) pattern change or recent onset of new headache; (7) positional headache; (8) precipitated by sneezing, coughing, or exercise; (9) papilledema; (10) progressive headache and atypical presentations; (11) pregnancy or puerperium; (12) painful eye with autonomic features; (13) posttraumatic onset of headache; (14) pathology of the immune system such as HIV; (15) painkiller overuse or new drug at onset of headache. Using the systematic SNNOOP10 list to screen new headache patients will presumably increase the likelihood of detecting a secondary cause. The lack of prospective epidemiologic studies on red flags and the low incidence of many secondary headaches leave many questions unanswered and call for large prospective studies. A validated screening tool could reduce unneeded neuroimaging and costs.

scholarly journals The Value of Cranial CT Imaging in Patients With Headache at the Emergency Department

2021 ◽  
Vol 12 ◽  
Author(s):  
Cynthia M. C. Lemmens ◽  
M. Christien van der Linden ◽  
Korné Jellema
Keyword(s):  
Emergency Department ◽  
Diagnostic Imaging ◽  
Ct Imaging ◽  
Secondary Headache ◽  
Headache Disorders ◽  
Focal Neurological Deficit ◽  
Cranial Ct ◽  
Imaging Results ◽  
Headache Onset ◽  
Headache Patients

Background: Headache is among the most prevalent complaints in patients presenting to the emergency department (ED). Clinicians are faced with the difficult task to differentiate primary (benign) from secondary headache disorders, since no international guidelines currently exist of clinical indicators for neuroimaging in headache patients.Methods: We performed a retrospective review of 501 patients who presented at the ED with headache as a primary complaint between April 2018 and December 2018. Primary outcomes included the amount of diagnostic imaging, the different conclusions provided by diagnostic imaging, and the clinical factors associated with abnormal imaging results.Results: About half of the patients were diagnosed with a primary headache disorder. Cranial CT imaging at the ED was performed regularly (61% of the patients) and led to the diagnosis of underlying pathology in 1 in 7.6 patients. In a multivariate model, factors significantly associated with abnormal cranial CT results were age 50 years or older, presentation within 1 h after headache onset, clinical history of aphasia, and focal neurological deficit at examination.Conclusions: As separate clinical characteristics have limited value in detecting severe underlying headache disorders, cranial imaging is regularly performed in the ED. Clinical prediction model tools applied to headache patients may identify patients at risk of intracranial pathology prior to diagnostic imaging and reduce cranial imaging in the future.

scholarly journals Brief Research Note: A Comparison of the Provision of Counselling and Advice to Primary Care Patients in Emergency Departments and a General Practice Casualty Department

2002 ◽  
Vol 8 (1) ◽  
pp. 91 ◽  
Author(s):  
Patrick Bolton ◽  
Michael Mira
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
General Practice ◽  
General Practitioner ◽  
Emergency Departments ◽  
Adverse Outcome ◽  
Triage Nurse ◽  
Ambulatory Patients ◽  
Primary Care Patients ◽  
Research Officer

Data were collected from clinicians at the time of consultation about the care that they provided in 12,813 encounters in a general practitioner (GP) staffed casualty department and 719 primary care encounters in two emergency departments (Bolton, 1999). Data were collected by the GPs themselves in general practice, and by a research officer located in the emergency departments. Patients seen in the emergency department were ambulatory patients whom the triage nurse assessed would not suffer an adverse outcome if they had to wait an hour or longer for care. Comparison of these two patient populations established that they were similar in terms of age, gender, ethnicity, and reason for encounter.

General Practice in Canada

1972 ◽  
Vol 2 (2) ◽  
pp. 229-237 ◽  
Author(s):  
I. R. McWhinney
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practitioner ◽  
Family Physician ◽  
Hospital Care ◽  
Rapid Change ◽  
Teaching Hospitals ◽  
Physician Services ◽  
District Hospitals ◽  
Tier System

Medical practice in Canada is in a stage of rapid change. All provinces now have government insurance schemes which pay for hospital care and physician services. Health care is being reorganized in several provinces. The pattern evolving is a three–tier system, with health centers for primary care, district hospitals for inpatient care, and regional hospitals—usually teaching hospitals—for highly specialized services. A regional administrative structure is being developed. Although many variations exist the general practitioner (family physician) is still the major source of primary care. Current trends indicate that in the future the family physician will continue to be the usual source of primary and continuing health care. General practitioners in Canada normally have hospital admission privileges. Although the role of the general practitioner in hospital is changing, there is no indication that the general practitioner will cease to play a part in hospital care. Nurses are beginning to play a more important role in primary health care. Most Canadian medical schools now have departments or divisions of family medicine. The College of Family Physicians has played a major part in establishing postgraduate training for family practice.

Headache in the pediatric emergency department: A 5-year retrospective study

Cephalalgia ◽  
2017 ◽  
Vol 38 (11) ◽  
pp. 1765-1772 ◽  
Author(s):  
Roberta Rossi ◽  
Antonia Versace ◽  
Barbara Lauria ◽  
Giulia Grasso ◽  
Emanuele Castagno ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cranial Nerves ◽  
Primary Headache ◽  
Pediatric Emergency ◽  
Secondary Headache ◽  
Pediatric Emergency Department ◽  
Red Flags ◽  
Exact Test ◽  
Headache Centre ◽  
Chi Squared

Aim To determine the red flags for serious organic causes of headache in children, to analyze if the management of headache in the Pediatric Emergency Department is appropriate, and whether the follow-up may limit repeated visits to the Emergency Department. Methods All the patients ≤ 18 years referred to our pediatric Emergency Department for non-traumatic headache over 5 years were retrospectively reviewed. The patients followed up by the Pediatric Headache Centre were also screened. Statistical analysis was undertaken using the Chi-squared test or Fisher’s exact test and multivariate analysis; significance at p < 0.05. Results 1833 patients (54.6% males) accessed our Emergency Department 2086 times; 62.1% had primary headache, 30.0% had secondary headache, 7.8% received inconsistent diagnosis. Among those with secondary headache, 24 (1.1% of total visits) were diagnosed with serious disorders. The clinical red flags for “serious headache” were: Cranial nerves palsy, strabismus, and drowsiness. One hundred and eighty four patients (8.8 %) underwent neuroimaging (rate of pathological findings: 7.1 %); 37.2 % of the patients received analgesic therapy. One hundred and fifteen patients (6.2 %) returned within three months; 24 of these were referred to the Headache Centre, with only one accessing the Emergency Department again. Conclusions The vast majority of headaches referred to the Pediatric Emergency Department are benign, and primary forms prevail. “Serious headache” is rare and shows typical clinical features and abnormal neurologic evaluation; specific clinical red flags, along with suggestive personal history, should lead the pediatrician to prescribe only appropriate neuroimaging. Pain relief is still insufficient in the Pediatric Emergency Department despite appropriate guidelines. Last, the collaboration with the Headache Centre is crucial to limit repeated visits.

scholarly journals MP25: The role of advanced imaging in the management of benign headaches in the emergency department: a systematic review

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S73 ◽  
Author(s):  
R. Lepage ◽  
L. Krebs ◽  
S.W. Kirkland ◽  
C. Alexiu ◽  
S. Campbell ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Ct Scans ◽  
Secondary Headache ◽  
Advanced Imaging ◽  
Ct Utilization ◽  
Weighted Median ◽  
Ct Head ◽  
Study Population ◽  
Headache Patients

Introduction: Headache is a common emergency department (ED) presentation. Benign (i.e., non-pathological) headaches are particularly common, including exacerbations of chronic migraine, tension, and cluster headache. Several studies have reported concerns over the frequent use of advanced imaging, specifically computed tomography (CT), in the ED management of benign or primary headache presentations. This systematic review examined the proportion of adult ED benign headache presentations who receive a CT(head). Methods: Eight bibliographic databases and the grey literature were searched. All studies reporting the proportion of benign headache patients receiving a CT(head) in the ED were eligible for inclusion. Studies which included a secondary headache population of 15% of their total study population or less where eligible for inclusion. Two reviewers independently assessed study inclusion and completed quality assessment and data extraction. Weighted medians were calculated for the primary and secondary outcomes, as appropriate. Results: The search returned 2,444 unique citations, of which 20 met the inclusion criteria (21 patient groups were analyzed). The majority of the studies were descriptive in nature and conducted in North America. The reported proportion of benign headache patients receiving a CT(head) varied considerably (range: 2.06-67.21%); with a weighted median of 30.0% (interquartile range: 30.0, 30.0). Studies published in 2000 or later (18/21 groups) were found to have a higher weighted median percentage compared to those published pre-2000 (p=0.016). Neither the country of origin nor the proportion of patients with secondary headache included within the study population had a significant effect on CT utilization. Of the three studies which reported the discharge diagnosis of all patients, sub-arachnoid hemorrhage was discovered in 2/241 (0.83%) of CT scans. Conclusion: Considerable variation in CT utilization for benign headache ED presentations exists and estimates indicate that more than a quarter of patients receive a CT(head). Overall, these CT scans rarely identify significant pathology, suggesting imaging may be safely reduced. Further research is required to identify interventions which can safely and effectively reduce unnecessary imaging among headache presentations.

A. I. F. Scott & C. P. L. Freeman's “Edinburgh Primary Care Depression Study”

1994 ◽  
Vol 164 (3) ◽  
pp. 410-415 ◽  
Author(s):  
J. Scott ◽  
C. A. L. Moon ◽  
C. V. R. Blacker ◽  
J. M. Thomas
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Cost Benefit Analysis ◽  
Routine Care ◽  
Depressive Illness ◽  
Clinical Psychologist ◽  
Behaviour Therapy ◽  
General Practitioner Care ◽  
Cognitive Behaviour ◽  
Specialist Treatment

“Objective - To compare the clinical efficacy, patient satisfaction, and cost of three specialist treatments for depressive illness with routine care by general practitioners in primary care. Design - Prospective, randomised allocation to amitriptyline prescribed by a psychiatrist, cognitive behaviour therapy from a clinical psychologist, counselling and case work by a social worker, or routine care by a general practitioner. Subjects and setting - 121 patients aged between 18 and 65 years suffering depressive illness (without psychotic features) meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition for major depressive episode in 14 primary care practices in southern Edinburgh. Main outcome measures - Standard observer rating of depression at outset and after four and 16 weeks. Numbers of patients recovered at four and 16 weeks. Total length and cost of therapist contact. Structured evaluation of treatment by patients at 16 weeks. Results - Marked improvement in depressive symptoms occurred in all treatment groups over 16 weeks. Any clinical advantage of specialist treatments over routine general practitioner care were small, but specialist treatment involved at least four times as much therapist contact and cost at least twice as much as routine general practitioner care. Psychological treatments, especially social work counselling, were most positively evaluated by patients. Conclusions - The additional costs associated with specialist treatments of new episodes of mild to moderate depressive illness presenting in primary care were not commensurate with their clinical superiority over routine general practitioner care. A proper cost-benefit analysis requires information about the ability of specialist treatment to prevent future episodes of depression.”

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