Emergency department headache admissions in an acute care hospital:why do they occur and what can we do about it?

Abstract

Introduction: Many patients present to the Emergency Department (ED) complaining of headache and a significant proportion of these visits would result in hospital admissions. This study analyses the demographics, presentation, work-up, reasons for admission, diagnoses and outcomes of patients admitted with the chief complaint of headache--to identify possible ways of reducing such admissions.

Materials and methods: A retrospective analysis was done of the electronic medical records/discharge summaries of all adult patients admitted during a 1-year period from January to December 2006 with the diagnosis of primary headaches or secondary headaches not related to trauma, intracranial infection, inflammation, mass lesion, raised intracranial pressure or a serious systemic illness from the ED of the National University Hospital of Singapore.

Results: One thousand two hundred and seventy-six patients presented to the adult ED with primary headaches or secondary headaches not related to serious conditions in 2006. This represented 2% of the ED attendances in the period. Two hundred and twenty-three patients were admitted for various reasons--diagnostic uncertainty: 110 (49%), pain control: 73 (33%), social/patient request: 60 (27%) and others: 4 (2%). Sixty-six per cent of the patients had either computed tomography (CT) or magnetic resonance (MR) head imaging. Eighteen patients (8%) were eventually diagnosed with a "potentially serious" diagnosis (intracranial haemorrhage, brain metastasis, stroke, meningitis, cerebral inflammation, cysticercosis, cervical osteomyelitis, hydrocephalus, seizure and malignant hypertension).

Conclusion: Specific strategies addressing the various reasons for admission including physician training, use of evaluation protocols, imaging to exclude secondary pathology, a longer duration of treatment and evaluation in the ED, effective pain control and patient education may help reduce headache admissions.