RESUMO
OBJECTIVE: To describe the variability in diagnostic testing and treatment of headaches in children presenting to the emergency department (ED) with use of a nationally representative sample. STUDY DESIGN: This was a retrospective cohort study using the National Hospital Ambulatory Medical Care Survey during 2005-2009. To assess the use of evidence-based treatment, we analyzed all patients <18 years old in 2 groups: (1) primary discharge diagnosis of headache and (2) discharge diagnosis of migraine. RESULTS: Four hundred forty-eight sampled ED visits from 2005-2009 represented a national estimate of 1.7 million visits with a discharge diagnosis of headache. A total of 95 visits represented a national estimate of 340â000 visits with a discharge diagnosis of migraine. Median age was 13.1 years and 60% were female with a primary diagnosis of headache. In this group, neuroimaging was performed in 37% of patients and 39% underwent blood tests. Nonsteroidal anti-inflammatory drugs and opioids were most commonly used for treatment. For children with a discharge diagnosis of migraine, approximately 40% of patients received non-evidence-based treatment, most commonly with opioid medications, and >20% of patients underwent computed tomography scanning. CONCLUSIONS: There is significant variability in the evaluation and treatment of pediatric headache in the ED. Despite evidence-based clinical guidelines for migraine headache, a large number of children continue to receive opioids and ionizing radiation in the ED.
Assuntos
Tratamento de Emergência , Cefaleia/diagnóstico , Cefaleia/terapia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Masculino , Estudos RetrospectivosRESUMO
OBJECTIVE: To examine quantitative end-tidal carbon dioxide (ETCO(2)) in children with acute exacerbations of asthma. We hypothesize that quantitative ETCO(2) will be lower in children during an acute exacerbation of asthma and will correlate with the severity of the exacerbation. We also hypothesize that ETCO(2) can be successfully performed in all groups in the setting of a pediatric emergency department. STUDY DESIGN: Patients with acute exacerbation of asthma (n = 86) and control subjects without respiratory or metabolic disturbances (n = 88) were prospectively enrolled in a pediatric emergency department. A physical examination, vital signs, and ETCO(2) measurements were performed on arrival and, in the patients with asthma, after each bronchodilator treatment. RESULTS: ETCO(2) was measured successfully in 97% of enrolled children. After adjusting for respiratory rate, ETCO(2) was significantly lower in patients with acute exacerbation of asthma than in control subjects (P < .001). ETCO(2) measured after the first and after the final bronchodilator treatment were significantly associated with the number of bronchodilator treatments received and with hospital admission (P < or = .002). CONCLUSIONS: ETCO(2) can be successfully measured in all children and is significantly lower in children with acute exacerbations of asthma compared with healthy control subjects. Quantitative ETCO(2) may be an objective, noninvasive, and effort-independent way to assess the severity of asthma.