A Modern Epidemic: Increasing Pediatric Emergency Department Visits and Admissions for Headache

Abstract

Objective: Headaches represent 0.9% to 2.6% of visits to a pediatric emergency department (PED). We noted a trend of increasing visits for headache in our tertiary care PED and sought to further characterize this trend.

Methods: We identified PED visits with International Classification of Disease, Ninth Revision, Clinical Modification diagnoses for headache at 25 hospitals in Pediatric Health Information System between 2003 and 2013. To further characterize demographics and treatment trends over time we used the electronic health record in our emergency department to identify children ages four to 18 between January 2007 and December 2014 with International Classification of Disease, Ninth Revision codes for headache: a random sample of 50 visits per year were chosen for chart review.

Results: Pediatric Health Information System visits for headache increased by 166% (18,041 in 2003 and 48,020 in 2013); by comparison, total PED visits increased by 57.6%. The percent admission increased by 300% (2020 admissions in 2003 and 8087 admissions in 2013). At our hospital, headache visits increased 111% from 896 visits in 2007 to 1887 visits in 2014; total PED visits increased 30.2%. The admission percentage for headache increased 187% with 156 admissions in 2007 and 448 in 2014. Management over time differed in the frequency of head computed tomography which decreased 3.7% per year (r = -0.93, 95% CI -0.99, -0.64) from 34% in 2007 to 18% in 2014.

Conclusion: Pediatric emergency department visits for headache are increasing and a growing proportion of these patients are admitted. This finding identifies a potential patient population to target for interventions to improve outpatient management and reduce pediatric emergency department utilization.

Keywords: Emergency department; Headache; Imaging; Pediatric; Trend.

FIGURE 1.

Relative changes in headache and total PED visit rates over time. The graphing of percent change number of total and headache PED visits shows that the increase in visits for headaches is not merely accounted for by the increase in total PED visits. PED, pediatric emergency department.

FIGURE 2.

Increasing admission rate for PED headache visits. The increase in the number of admissions for headache is attributable to both a rising number of PED visits for headache and by a rising portion of headache PED visits resulting in admission, as soon in Fig 2. PED, pediatric emergency department.

FIGURE 3.

Adjusted^a headache visits and admissions relative to ED visits and admissions, 2007-2014. At a single tertiary PED, the number of visits for headache and admission for headache rose out of portion to the rise in total PED visits and admissions respectively. ^aIndividual chart review revealed that not all visits or admissions with a ICD-9 code for headache had a documented complaint or diagnosis of headache. The total number of visits and admissions for headache ICD-9 codes was adjusted to account for this discrepancy. Triangles represent headaches admissions per 1000 ED admissions. Circles represent headache visits per 1000 ED visits. ICD-9, International Classification of Disease, Ninth Revision; PED, pediatric emergency department.

FIGURE 4.

Head imaging for headache in PED. The number of CTs performed for PED visits for headache has decreased while the use of MRI has increased. The number of patients with no previously documented head imaging and no head imaging performed during the index visit, termed imaging naiveté, has not changed significantly. PED, pediatric emergency department.