THE CLINICAL APPROACH TO HEADACHE IN THE EMERGENCY DEPARTMENT AND A COST ANALYSIS OF HEADACHE IN THE EMERGENCY MEDICINE SETTING
Relevance. Headaches are among the most common causes for emergency department (ED) referrals. The aim of the present study was to analyze and review the costs of the patients who referred to ED due to headache. Materials and methods. This study was conducted prospectively with patients who have referred because of headache between September, 1, 2017 and December, 31, 2017 (3 months. Age, gender, educational status, characteristics, smoking status and alcohol use, comorbidities, predisposing factors, headache characteristics, additional symptoms, physical examination findings, vital parameters, examinations ordered, and cost analysis were performed. The patients were divided into two groups as primary and secondary headache. The differences between Primary headache (PHA) and Secondary headache (CHA) of these data were evaluated. Results. The median age of the patients was 40 (IQR:22) years;67.3% of the patients were female. The rate of the patients with PHA was 73.3% whereas 26.7% of the patients were SHA. The median age of the patients with SHA was detected higher than the patients with PHA (p<0.05). There was not any difference for gender, occupation, and social habits (p>0.05). Coronary artery disease (CAD), malignancy and chronic obstructive pulmonary disease (COPD)/asthma prevalence were significantly higher in patients with SHA (p<0.05). The frequency of PHA after stress, fatigue, insomnia, increased mental activity and intake of certain foods was detected higher (p <0.05). The prevalence of sudden onset was higher in patients with SHA (p<0.05). Location, characteristics, severity, and duration of the pain were detected similar between both groups (p>0.05). It was determined that overall condition was better in patients with PHA, and the rate of head & neck and neurological conditions was detected higher in patients with SHA (p <0.05). Fever and lower saturation levels were significantly higher in patients with SHA (p<0.05). Pathological findings were detected in 50% of hemogram analyses, 66.7% of blood gas analyses, 41.6% of complete blood count analyses, 75% of direct X-rays, 42.8% of CTs, 75% of 4 diffusion MRIs, and 50% of LP analyses. Mean ED cost of patients with PHA was 2.3 USD (IQR: 1.2USD), and mean ED cost of patients with SHA was 13.3 USD (IQR: 17.5 $). ED cost of patients with SHA was significantly higher than those with PHA (p<0.05). Conclusion. It was detected that costs of patients whom SHA was considered are higher than those whom PHA was considered. The most significant cause for this depends on the fact that some symptoms and findings exist both in PHA and SHA. We believe that a comprehensive evaluation of these patients may reduce the number of tests and costs accordingly.
Kaan Çelik1, Cemil Kavalcı2 1 Bolu İzzet Baysal University Faculty of Medicine, Emergency department, Turkey 2 Antalya Training and Research Hospital, Emergency department, Turkey
1. Açıkgöz N.P., İlhan A. İlimizde Genç Erişkin ve Erişkin Yaş Grubu Bireylerde Baş Ağrısı Karakteristikleri.J Turgut Ozal Med Cent 2013:20(3):232-6. 2. Bahra A., Evans R.W. The Secondary Headaches. SAGE Publications Sage UK: London, England; 2021. pp.56-59 3. Clinch C.R. Evaluation of acute headaches in adults. American family physician. 2001;63(4):685. 4. Davis-Martin R.E., Polk A.N., Smitherman T.A. Alcohol use as a comorbidity and precipitant of primary headache: review and meta-analysis. Current pain and headache reports. 2017;21(10):1-12. 5. Duran A. Psikiyatride ilaçla tedavi. İ.Ü. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri 2008 S:275-302. 6. Filler L., Akhter M., Nimlos P., editors. Evaluation and management of the emergency department headache. Seminars in neurology; 2019: Thieme Medical Publishers. p.450 7. Friedman B.W., Hochberg M.L., Esses D., Grosberg B., Corbo J., Toosi B., et al. Applying the International Classification of Headache Disorders to the emergency department: an assessment of reproducibility and the frequency with which a unique diagnosis can be assigned to every acute headache presentation. Annals of emergency medicine. 2007;49(4):409-19. e9. 8. Giamberardino M.A., Affaitati G., Costantini R., Guglielmetti M., Martelletti P. Acute headache management in emergency department. A narrative review. Internal and emergency medicine. 2020;15(1):109-17. 9. Gilbert J.W., Johnson K.M., Larkin G.L., Moore C.L. Atraumatic headache in US emergency departments: recent trends in CT/MRI utilisation and factors associated with severe intracranial pathology. Emergency medicine journal. 2012;29(7):576-81. 10. Handschin N., Oppliger M., Brehm A., Psychogios M., Bonati L., Nickel C.H., et al. Nontraumatic Headache in Adult Emergency Patients: Prevalence, Etiologies, and Radiological Findings. Journal of clinical medicine. 2020;9(8):2621. 11. Johnsen M.B., Winsvold B., Børte S., Vie G.Å., Pedersen L.M., Storheim K., et al. The causal role of smoking on the risk of headache. A Mendelian randomization analysis in the HUNT study. European journal of neurology. 2018;25(9):1148-e102. 12. Jordan Y.J., Lightfoote J.B., Jordan J.E. Computed tomography imaging in the management of headache in the emergency department: cost efficacy and policy implications. Journal of the national medical association. 2009;101(4):331-5. 13. Kahn C.E., Jr., Sanders G.D., Lyons E.A., Kostelic J.K., MacEwan D.W., Gordon W.L. Computed tomography for nontraumatic headache: current utilization and cost-effectiveness. Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes. 1993;44(3):189-93 14. Karadaş Ö. Tension Type Headache: Evaluation of Chronic Type.J Clin Anal Med 2013;4(6): 522-6. 15. Locker T.E., Thompson C., Rylance J., Mason S.M. The utility of clinical features in patients presenting with nontraumatic headache: an investigation of adult patients attending an emergency department. Headache: The Journal of Head and Face Pain. 2006;46(6):954-61. 16. Locker T.E., Thompson C., Rylance J., Mason S.M. The utility of clinical features in patients presenting with nontraumatic headache: an investigation of adult patients attending an emergency department. Headache: The Journal of Head and Face Pain. 2006;46(6):954-61. 17. Maizels M. The patient with daily headaches. American family physician. 2004;70(12):2299-306. 18. Mert E., Özge A., Taşdelen B., Yılmaz A., Bilgin N.G. What clues are available for differential diagnosis of headaches in emergency settings? The journal of headache and pain. 2008;9(2):89-97. 19. Miller D.G., Vakkalanka P., Moubarek M.L., Lee S., Mohr N.M. Reduced Computed Tomography Use in the Emergency Department Evaluation of Headache Was Not Followed by Increased Death or Missed Diagnosis. The western journal of emergency medicine. 2018;19(2):319-26. 20. Mu J., Chen T., Quan S., Wang C., Zhao L., Liu J. Neuroimaging features of whole‐brain functional connectivity predict attack frequency of migraine. Human brain mapping. 2020;41(4):984-93. 21. Munoz-Ceron J., Marin-Careaga V., Peña L., Mutis J., Ortiz G. Headache at the emergency room: Etiologies, diagnostic usefulness of the ICHD 3 criteria, red and green flags. PLoS One. 2019;14(1):e0208728. 22. Newman L.C., Lipton R.B.. Emergency department evaluation of headache. Neurologic clinics. 1998;16(2):285-303. 23. Quon J.S., Glikstein R., Lim C.S., Schwarz B.A. Computed tomography for non-traumatic headache in the emergency department and the impact of follow-up testing on altering the initial diagnosis. Emergency radiology. 2015;22(5):521-5. 24. Rasmussen B.K., Jensen R., Olesen J. Impact of headache on sickness absence and utilisation of medical services: a Danish population study. Journal of epidemiology and community health. 1992;46(4):443-6. 25. Roslan M.Z. Relationship Between The Number of Cigarettes Per Day and Caffeine Intake on Headache Intensity in Faculty of Medicine Student Batch 2016 of Universitas Sumatera Utara. Asian Australasian Neuro and Health Science Journal (AANHS-J). 2020;2(1). 13. Şahin A., Vildan Ö., Tatli Ö., Karaca Y., Yaman S.Ö., Karahan S.C. Acil servise izole baş ağrisi şikayetiyle başvuran hastalarin ayirici tanisinda iskemi modifiye albumin seviyesinin değeri. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi. 2018;20(1):1-7. 26. Şirin T.C. Ağrı Devlet Hastanesine başvuran migren hastalarının klinik ve sosyodemografik özellikleri. Ege Tıp Dergisi. 2017;56(3):128-34. 27. Silberstein S.D. Migraine symptoms: result of a survey of self-reported migraineurs. Headache 1995;35: 387-96. 28. Society HCCotIH. The international classification of headache disorders, (beta version). Cephalalgia. 2013;33(9):629-808.
: 38

:

Сelik K., Kavalcı C. The clinical approach to headache inthe emergency department and a cost analysis of headache in the emergency medicine setting // Nauka i Zdravookhranenie [Science & Healthcare]. 2021, (Vol.23) 3, pp. 78-86. doi 10.34689/SH.2021.23.3.009 Челик К., Кавальчи Дж. Клинический подход и анализ затрат на пациентов с головной болью в условиях отделения неотложной медицины // Наука и Здравоохранение. 2021. 3(Т.23). С. 78-86. doi 10.34689/SH.2021.23.3.009 Челик К., Кавальчи Дж. Шұғыл медицина бөлімшесі жағдайында бас ауруы бар пациенттерге арналған клиникалық тәсіл және шығындарды талдау // Ғылым және Денсаулық сақтау. 2021. 3 (Т.23). Б. 78-86. doi 10.34689/SH.2021.23.3.009