Predictive Factors and Clinical Prediction Score for Serious Intracranial Causes in Acute Nontraumatic Headache at an Emergency Department
Purpose. The objectives of this study were to investigate the predictive factors and develop a clinical prediction score to identify serious intracranial causes in acute nontraumatic headache (NTH). Methods. A retrospective chart review study was conducted from 2013 to 2018 in acute NTH patients who...
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| Language: | English |
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Wiley
2019-01-01
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| Series: | Emergency Medicine International |
| Online Access: | http://dx.doi.org/10.1155/2019/4267825 |
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| author | Siriwimon Tantarattanapong Lalita Chalongkulasak |
| author_facet | Siriwimon Tantarattanapong Lalita Chalongkulasak |
| author_sort | Siriwimon Tantarattanapong |
| collection | DOAJ |
| description | Purpose. The objectives of this study were to investigate the predictive factors and develop a clinical prediction score to identify serious intracranial causes in acute nontraumatic headache (NTH). Methods. A retrospective chart review study was conducted from 2013 to 2018 in acute NTH patients who visited the emergency department. The patients were divided into serious intracranial headache and nonserious intracranial headache groups. The two groups were compared in regard to the baseline characteristics, clinical presentation, physical examination, investigation, and diagnosis. The significant factors to predict a serious intracranial cause were examined using a multivariate logistic regression model. The coefficients from the multivariate logistic regression were used to plot the receiver operating characteristic curve to develop a clinical prediction score. Results. From 2,372 patients, 454 met the inclusion criteria. Of the 454 patients with acute NTH, 88 (19.4%) patients were serious intracranial cause. The seven significant factors that predicted serious intracranial cause were abrupt onset (odds ratio (OR) 7.96, 95% confidence interval (CI) 2.77‒22.91), awakening pain (OR 3.14, 95% CI 4.15–6.82), duration of headache >1 week (OR 10.59, 95% CI 2.9–38.7), fever (OR 6.01, 95% CI 2.07–17.46), worst headache ever (OR 12.95, 95% CI 5.69–29.45), alteration of consciousness (OR 13.55, 95% CI 2.07‒88.88), and localizing neurological deficit (OR 5.28, 95% CI 1.6‒17.46). A score ≥3 out of 10 points of the clinical prediction score was likely to identify a serious intracranial cause of acute NTH with a sensitivity and specificity of 87.50% (95% CI 78.73–93.59%) and 87.70% (95% CI 83.90–90.89%), respectively. The area under the curve was 0.933. Conclusion. Abrupt onset, awakening pain, duration of headache >1 week, fever, worst headache ever, alteration of consciousness, and localizing neurological deficit were the significant predictive factors for serious intracranial cause of acute NTH. |
| format | Article |
| id | doaj-art-332cc66abd724acab36ec0246e01a157 |
| institution | Kabale University |
| issn | 2090-2840 2090-2859 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Emergency Medicine International |
| spelling | doaj-art-332cc66abd724acab36ec0246e01a1572025-02-03T05:51:50ZengWileyEmergency Medicine International2090-28402090-28592019-01-01201910.1155/2019/42678254267825Predictive Factors and Clinical Prediction Score for Serious Intracranial Causes in Acute Nontraumatic Headache at an Emergency DepartmentSiriwimon Tantarattanapong0Lalita Chalongkulasak1Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, ThailandDepartment of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, ThailandPurpose. The objectives of this study were to investigate the predictive factors and develop a clinical prediction score to identify serious intracranial causes in acute nontraumatic headache (NTH). Methods. A retrospective chart review study was conducted from 2013 to 2018 in acute NTH patients who visited the emergency department. The patients were divided into serious intracranial headache and nonserious intracranial headache groups. The two groups were compared in regard to the baseline characteristics, clinical presentation, physical examination, investigation, and diagnosis. The significant factors to predict a serious intracranial cause were examined using a multivariate logistic regression model. The coefficients from the multivariate logistic regression were used to plot the receiver operating characteristic curve to develop a clinical prediction score. Results. From 2,372 patients, 454 met the inclusion criteria. Of the 454 patients with acute NTH, 88 (19.4%) patients were serious intracranial cause. The seven significant factors that predicted serious intracranial cause were abrupt onset (odds ratio (OR) 7.96, 95% confidence interval (CI) 2.77‒22.91), awakening pain (OR 3.14, 95% CI 4.15–6.82), duration of headache >1 week (OR 10.59, 95% CI 2.9–38.7), fever (OR 6.01, 95% CI 2.07–17.46), worst headache ever (OR 12.95, 95% CI 5.69–29.45), alteration of consciousness (OR 13.55, 95% CI 2.07‒88.88), and localizing neurological deficit (OR 5.28, 95% CI 1.6‒17.46). A score ≥3 out of 10 points of the clinical prediction score was likely to identify a serious intracranial cause of acute NTH with a sensitivity and specificity of 87.50% (95% CI 78.73–93.59%) and 87.70% (95% CI 83.90–90.89%), respectively. The area under the curve was 0.933. Conclusion. Abrupt onset, awakening pain, duration of headache >1 week, fever, worst headache ever, alteration of consciousness, and localizing neurological deficit were the significant predictive factors for serious intracranial cause of acute NTH.http://dx.doi.org/10.1155/2019/4267825 |
| spellingShingle | Siriwimon Tantarattanapong Lalita Chalongkulasak Predictive Factors and Clinical Prediction Score for Serious Intracranial Causes in Acute Nontraumatic Headache at an Emergency Department Emergency Medicine International |
| title | Predictive Factors and Clinical Prediction Score for Serious Intracranial Causes in Acute Nontraumatic Headache at an Emergency Department |
| title_full | Predictive Factors and Clinical Prediction Score for Serious Intracranial Causes in Acute Nontraumatic Headache at an Emergency Department |
| title_fullStr | Predictive Factors and Clinical Prediction Score for Serious Intracranial Causes in Acute Nontraumatic Headache at an Emergency Department |
| title_full_unstemmed | Predictive Factors and Clinical Prediction Score for Serious Intracranial Causes in Acute Nontraumatic Headache at an Emergency Department |
| title_short | Predictive Factors and Clinical Prediction Score for Serious Intracranial Causes in Acute Nontraumatic Headache at an Emergency Department |
| title_sort | predictive factors and clinical prediction score for serious intracranial causes in acute nontraumatic headache at an emergency department |
| url | http://dx.doi.org/10.1155/2019/4267825 |
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