From the University of Sheffield, School of Health and Related Research, Sheffield, UK (Drs. Locker and Mason); Northern General Hospital, Emergency Department, Sheffield, UK (Drs. Locker and Mason); Addenbrookes Hospital, Emergency Department, Cambridge, UK (Dr. Thompson); and Royal Hallamshire Hospital, Department of Medicine, Sheffield, UK (Dr. Rylance).
The Utility of Clinical Features in Patients Presenting With Nontraumatic Headache: An Investigation of Adult Patients Attending an Emergency Department
Article first published online: 29 MAR 2006
Headache: The Journal of Head and Face Pain
Volume 46, Issue 6, pages 954–961, June 2006
How to Cite
Locker, T. E., Thompson, C., Rylance, J. and Mason, S. M. (2006), The Utility of Clinical Features in Patients Presenting With Nontraumatic Headache: An Investigation of Adult Patients Attending an Emergency Department. Headache: The Journal of Head and Face Pain, 46: 954–961. doi: 10.1111/j.1526-4610.2006.00448.x
- Issue published online: 29 MAR 2006
- Article first published online: 29 MAR 2006
- Accepted for publication January 18, 2006.
- emergency department
Objective.—When patients present to an emergency department because of nontraumatic headache, they often present a diagnostic challenge. This study aimed to examine the utility of clinical features in detecting serious underlying causes of nontraumatic headache in adult patients presenting to an emergency department.
Methods.—A prospective observational study of alert adult patients presenting to 1 UK emergency department over a period of 14 months was conducted. Patients were excluded if their headache was related to trauma or they had been previously recruited into the study. A standardized data collection form was used to record details of the history and examination findings. Investigation and management were conducted according to the existing departmental protocols. Patients were followed up for 3 months following their initial presentation. Each factor in the history and examination was examined for its ability to predict a serious underlying cause of headache.
Results.—Five hundred and eighty-nine patients were included in the study with complete follow-up details obtained on 558 (94.7%) patients. Seventy-five (13.4%) patients were found to have a serious pathological cause of their headache. Four features were found to be significant independent predictors of serious pathology, these were age >50 years (likelihood ratio (LR) = 2.34), sudden onset, (LR = 1.74), any abnormality on neurological examination (LR = 3.56), and presentation due to associated features (LR = 2.27). Taken in combination, the presence of any 1 of the first 3 features has a sensitivity of 98.6% and specificity of 34.4% (Positive LR = 1.50, Negative LR = 0.04).
Conclusion.—Three features, age greater than 50, sudden onset, and an abnormal neurological examination, are identified as significant independent predictors of serious pathology, which, in combination, can exclude the presence of such pathology in adult patients presenting with nontraumatic headache.