Headache in the ED: predictors of later stroke admission identified

  • Liberman AL & al.
  • Am J Emerg Med
  • 07.11.2020

  • von Susan London
  • Clinical Essentials
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Takeaway

  • Among patients evaluated in the emergency department (ED) for headache, failures in diagnostic processes do not independently predict later hospitalization for stroke or transient ischemic attack (TIA).

Why this matters

Key results

  • Patients vs control participants:
    • Older mean age (64 vs 43 years).
    • Higher prevalences of traditional cerebrovascular risk factors:
      • Hypertension (87% vs 38%; P<.0001>
      • Diabetes (46% vs 16%; P<.0001>
      • Hyperlipidemia (42% vs 17%; P=.003).
      • Prior stroke/TIA (41% vs 2%; P<.0001>
    • Longer median ED stay (6.4 vs 5.3 hours; P=.03).
    • Higher rates of:
      • Neurological consultation (13% vs 4%; P=.03).
      • Neuroimaging (80% vs 48%; P<.0001>
      • Missing gait documentation (42% vs 26%; P=.03).
  • Groups similar on:
    • Headache characteristics.
    • Rates of:
      • Neurological examination.
      • Documented differential diagnoses.
      • Clear discharge follow-up plans.
  • Only independent predictor of subsequent stroke/TIA hospitalization was history of prior stroke/TIA.
    • OR, 29.01 (P=.01).

Study design

  • US single-center, case-control study of adult ED patients diagnosed with primary headache disorder:
    • 93 patients (hospitalization for ischemic stroke/TIA ≤365 days later).
    • 93 control participants (no such subsequent hospitalization).
  • Main outcome: ischemic stroke/TIA hospitalization.
  • Funding: None.

Limitations

  • Diagnostic processes were not validated.
  • Possible misclassification bias.
  • Unmeasured, residual confounding.
  • Uncertain generalizability.