A Modern Epidemic: Increasing Pediatric Emergency Department Visits and Admissions for Headache

Abstract

OBJECTIVE:Headaches represent 0.9% to 2.6% of visits to a pediatric emergency department (PED). We noted a trend of increasing visits for headache in our tertiary care PED and sought to further characterize this trend. METHODS:We identified PED visits with International Classification of Disease, Ninth Revision, Clinical Modification diagnoses for headache at 25 hospitals in Pediatric Health Information System between 2003 and 2013. To further characterize demographics and treatment trends over time we used the electronic health record in our emergency department to identify children ages four to 18 between January 2007 and December 2014 with International Classification of Disease, Ninth Revision codes for headache: a random sample of 50 visits per year were chosen for chart review. RESULTS:Pediatric Health Information System visits for headache increased by 166% (18,041 in 2003 and 48,020 in 2013); by comparison, total PED visits increased by 57.6%. The percent admission increased by 300% (2020 admissions in 2003 and 8087 admissions in 2013). At our hospital, headache visits increased 111% from 896 visits in 2007 to 1887 visits in 2014; total PED visits increased 30.2%. The admission percentage for headache increased 187% with 156 admissions in 2007 and 448 in 2014. Management over time differed in the frequency of head computed tomography which decreased 3.7% per year (r = −0.93, 95% CI −0.99, −0.64) from 34% in 2007 to 18% in 2014. CONCLUSION:Pediatric emergency department visits for headache are increasing and a growing proportion of these patients are admitted. This finding identifies a potential patient population to target for interventions to improve outpatient management and reduce pediatric emergency department utilization.

Epidemiology of Headache in Children and Adolescents—Another Type of Pandemia

“…Headache in children and adolescents is a growing medical but also social task. This is supported on the one hand by the increasing use of medical facilities by children and adolescents with headaches in recent years, as shown in data from South Korea, Italy, and the USA [11][12][13]. On the other hand, various studies have investigated headache prevalence, mostly in school-based cross-sectional studies, with the conclusion that there is a high prevalence of headache in children and adolescents globally (Fig.…”

Headache in the emergency department in Chongqing Province, China: A multicentre study

“…In the United States, up to 1-4% of emergency department visits is caused by headache [2,3]. Recently, a study on selfreported migraine or severe headache in the United States shows that approximately one in six Americans has been affected by headache in the past three months, and one in ve women has been affected by headache [4].…”

Rates of Presentation, Treatments and Serious Neurologic Disorders Among Children and Young Adults Presenting to US Emergency Departments With Headache

“…Headache is a frequent reason for children and young adults to present to the emergency department. 1,2 In the emergency department, health care providers are tasked with distinguishing primary versus secondary headaches. Findings from retrospective 1,3 -5 studies suggest that between 2% and 15% of pediatric patients with headache evaluated in the emergency department have an underlying serious etiology.…”

“…The investigations of headache in children and young adults have largely been limited to pediatric emergency departments, 2,3,13 -15 which represent a small fraction of overall emergency department encounters in this population. One prior investigation of 43 pediatric emergency departments suggested that rates of headache presentation were rising over time.…”

“…One prior investigation of 43 pediatric emergency departments suggested that rates of headache presentation were rising over time. 2 Other studies have been limited by their use of diagnosis codes to identify patients, which may fail to accurately identify patients with secondary headaches. 2,15 -17 Finally, although prior single-center investigations have attempted to identify rates of secondary headaches among pediatric patients with headache, 1,3 -5,18 the generalizability of such findings is unknown.…”