Open AccessPredictive Factors and Clinical Prediction Score for Serious Intracranial Causes in Acute Nontraumatic Headache at an Emergency Department
Author(s) -
Siriwimon Tantarattanapong,
Lalita Chalongkulasak
Publication year - 2019
Publication title -
emergency medicine international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.484
H-Index - 4
eISSN - 2090-2859
pISSN - 2090-2840
DOI - 10.1155/2019/4267825
Subject(s) - medicine , emergency department , logistic regression , confidence interval , odds ratio , receiver operating characteristic , clinical prediction rule , retrospective cohort study , pediatrics , psychiatry
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.