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Title: ER Diagnosis Post by tommyD on May 20th, 2006, 7:44am So lemme get this straight... the patient staggers into the ER wiith a serious CH and is asked to answer 100 questions? No wonder they coulkdn’t get a diagnosis on a third of patients. And no wonder they always have security guards at the ER... Acad Emerg Med Volume 13, Number 5_suppl_1 17, © 2006 Society for Academic Emergency Medicine HEADACHE An Assessment of the Reliability and Clinical Usefulness of the International Classification of Headache Disorders, 2nd Edition, for Emergency Department Headache Patients Benjamin Wolkin Friedman, Michael Hochberg, David Esses, Jill Corbo, Polly E. Bijur, Babak Toosi, Richard B. Lipton and E. John Gallagher Albert Einstein College of Medicine, Bronx, NY ABSTRACT Objectives: The International Headache Society's International Classification of Headache Disorders, 2nd edition (ICHD-2) is the standard guideline for classification of headaches. We conducted an in-depth interview to determine the extent to which this guideline classified emergency department (ED) headaches in a reliable and clinically useful manner. Methods: Cross-sectional investigation performed in an academic, urban ED from 3/04 to 8/05. Consecutive patients with nontraumatic headaches were enrolled, and underwent a detailed 100-question interview in the ED. The interview questionnaire has been previously validated against a comprehensive history, physical, and headache diary review by a headache specialist. Using the data from the interview and the subject's ED record, 2 emergency attending physicians (EPs) independently classified each of the headaches as primary or secondary and, if primary, then as migraine, tension-type headache (TTH), cluster headache, other primary headache, or primary headache unclassifiable. Interobserver discordance was adjudicated by an experienced headache specialist. Results: 480 consecutive patients were enrolled in the study. The EPs had a high level of interobserver agreement on presence of secondary headaches, migraines, and TTH (kappa = 0.80 to 0.88). 64% of the subjects had a primary headache, 26% of the subjects had a secondary headache, 10% of the subjects had coexisting primary and secondary headache, and in 20% of subjects, neither a primary nor a secondary headache could be diagnosed. Of 307 subjects with a primary headache, 59% had migraine, 11% had TTH, 1% had cluster headache, and 26% had an unclassifiable primary headache. Including the subjects for whom neither a primary nor a secondary headache could be diagnosed and those who had a primary headache disorder unclassifiable, 38% of subjects could not be given a specific ICHD-2 headache diagnosis. Conclusions: Although a detailed interview in the ED resulted in reliable classification, more than one-third of acute ED headaches could not be given a specific ICHD-2 diagnosis. |
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Title: Re: ER Diagnosis Post by clusterdeb on May 20th, 2006, 8:01am When I first started with CH, of course noone knew what was going on. My sister- in-law had just died from a cerebral aneurism at the same emergency room.(I work at this same hospital) Iam not saying it was there fault by no means. any way I had an attack thought I was going to see the light. praying to die. My hubby came home from work (cop) threw my in the back of the squad car flew to the hospital. Now picture this Im in my night gown, flip flops, old robe, cop escourting me in, Im rocking back and forth crying moaning crabbing my head. My friends in the back see this from the surveilance camera, and they say oh God weve got another physc. patient. with a police escourt. Boy, they were suprise to see me!!!!!!! Needless to say this was early and I was not diagnost yet, If I ever run out of imitrex and have to visit them they know what to get me. But, truly at that time I was psychotic, isnt everyone during a CH??? |
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