A pilot survey of decisions by acute medicine staff after thunderclap headache

Dobb, Benjamin R.; Cooper, Jamie G

doi:10.4997/jrcpe.2013.304

Cited by 5 publications

(4 citation statements)

References 51 publications

(66 reference statements)

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“…A recent survey of UK Emergency and Acute medicine clinicians confirms a wide variation in practice with only 74% of respondents following the recommended CT-LP pathway. 33 …”

Section: Discussionmentioning

confidence: 99%

Subarachnoid haemorrhage guidelines and clinical practice: a cross-sectional study of emergency department consultants' and neurospecialists' views and risk tolerances

et al. 2016

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ObjectivesTo establish if emergency medicine and neuroscience specialist consultants have different risk tolerances for investigation of suspected spontaneous subarachnoid haemorrhage (SAH), and to establish if their risk–benefit appraisals concur with current guidelines.Setting4 major neuroscience centres in London.Participants58 consultants in emergency medicine and neuroscience specialities (neurology, neurosurgery and neuroradiology) participated in an anonymous survey.Primary and secondary outcome measuresThe primary outcome measure was the highest stated acceptable risk of missing SAH in the neurologically intact patient presenting with sudden onset headache. Secondary outcome measures included agreement with guideline recommendations, risk/benefit appraisal and required performance of diagnostic tests, including lumbar puncture.ResultsEmergency department clinicians accepted almost 3 times the risk of a missed SAH diagnosis compared with the neuroscience specialists (2.8% vs 1.1%; p=0.02), were more likely to accept a higher risk of missed diagnosis for the benefit of a non-invasive test (p=0.04) and were more likely to disagree with current published guidelines stipulating the need for LP in all CT-negative cases (p=0.001).ConclusionsDivergence from recognised procedures for SAH investigation is often criticised and attributed to a lack of knowledge of guidelines. This study indicates that divergence from guidelines may be explained by alternative risk–benefit appraisals made by doctors with their patients. Guideline recommendations may gain wider acceptance if they accommodate the requirements of the doctors and patients using them. Further study of clinical risk tolerance may help explain patterns of diagnostic test use and other variations in healthcare delivery.

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“…A recent survey of UK Emergency and Acute medicine clinicians confirms a wide variation in practice with only 74% of respondents following the recommended CT-LP pathway. 33 …”

Section: Discussionmentioning

confidence: 99%

Subarachnoid haemorrhage guidelines and clinical practice: a cross-sectional study of emergency department consultants' and neurospecialists' views and risk tolerances

et al. 2016

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“…The local ethics review board approved the study (CP14/425-E) and we adhered to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines (24). The study was done according to the principles of the Declaration of Helsinki.…”

Section: Ethics Approvalmentioning

confidence: 99%

Management of thunderclap headache in the emergency room: A retrospective cohort study

et al. 2021

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Introduction The evaluation of red flags is crucial for the accurate the diagnosis of headache disorders, especially for thunderclap headache. We analysed if secondary headache disorders were adequately ruled out in patients that presented to the emergency room with thunderclap headache. Methods In this retrospective cohort study, we screened all patients that visited the emergency room for headache, including those that described thunderclap headache. We measured the frequency with which secondary causes were not adequately ruled out. We analysed the order of the exams, the final diagnosis, and the time elapsed between arrival, initial request for imaging, and the completion of the imaging. Results We screened 2132 patients, and 42 (1.9%) fulfilled eligibility criteria. Mean age was 43.1 ± 17.1 years, and 57% of patients were female. For 22 (52.4%) patients, the work-up was incomplete. Vascular study was missing in 16 (38.1%) patients, cerebrospinal fluid evaluation in nine (21.4%), and magnetic resonance imaging in seven (16.7%), with multiple assessments missing in six (14.3%). There were ten different combinations in which the exams were performed, with the most frequent being the second exam’s cerebral spinal fluid evaluation in 18 (52.9%) and the computed tomography angiogram in 10 (29.4%). A secondary cause of thunderclap headache was found in 16 (38.1%) patients, and four (9.5%) had a primary headache diagnosis after an adequate and complete study. Conclusions Thunderclap onset was described in one of every 50 patients that visited the emergency room for headache. More than half of these patients were not adequately managed. More than a third of thunderclap headache patients had a secondary cause.

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“…Nelle cefalee acute di nuova insorgenza la probabilità di individuare una causa potenzialmente grave è considerevolmente più elevata rispetto alla cefalea ricorrente. In Pronto Soccorso nelle situazioni di emergenza, circa il 5% dei pazienti con cefalea presenta una grave malattia neurologica di base [24]. L'esame obiettivo neurologico rappresenta il pri-mo passo essenziale nella valutazione del paziente: qualunque anomalia neurologica dovrebbe portare all'esecuzione di una TAC o di una RM encefalo.…”

Section: Le Cefalee Secondarieunclassified

Headaches: new classification, clinical and diagnostic criteria in General Medicine

Iurato

2014

CMI

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The classification system of headaches is one of the oldest in medicine, and includes a hugeamount of types and causes. The International Headache Society has listed two broad categoriesfor headache disorders: primary headache disorders, which lack a clear underlying causativepathology, and secondary headache disorders, that have a known cause. This is an overviewaddressed to general practitioners to help making a first-line headache diagnosis basing on themost common types of headache listed in the 2013 International Classification of Headachedisorder 3rd edition (beta version). Although headache diagnosis and treatment have madesubstantial gains in the last decade, the disease is still underdiagnosed and undertreated:improvements in several areas are required, especially in General Medicine.

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A pilot survey of decisions by acute medicine staff after thunderclap headache

Abstract: Most clinicians investigate neurologically intact patients with thunderclap headache following a CT/LP strategy, but deviations from recommended practice are common.

Cited by 5 publications

References 51 publications

Subarachnoid haemorrhage guidelines and clinical practice: a cross-sectional study of emergency department consultants' and neurospecialists' views and risk tolerances

Subarachnoid haemorrhage guidelines and clinical practice: a cross-sectional study of emergency department consultants' and neurospecialists' views and risk tolerances

Management of thunderclap headache in the emergency room: A retrospective cohort study

Headaches: new classification, clinical and diagnostic criteria in General Medicine

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