Simon Wells1, Ian G Stiell1,2, Evgeniya Vishnyakova3, Ronda Lun4, Marie-Joe Nemnom2, Jeffrey J Perry5,6. 1. Department of Emergency Medicine, Clinical Epidemiology Unit, The Ottawa Hospital, F647, 1053 Carling Avenue, Box 685, Ottawa, ON, K1Y 4E9, Canada. 2. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. 3. University of Ottawa, Ottawa, ON, Canada. 4. Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada. 5. Department of Emergency Medicine, Clinical Epidemiology Unit, The Ottawa Hospital, F647, 1053 Carling Avenue, Box 685, Ottawa, ON, K1Y 4E9, Canada. jperry@ohri.ca. 6. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. jperry@ohri.ca.
Abstract
PURPOSE: We sought to evaluate the factors associated with better outcomes for emergency department (ED) patients treated for primary headache. METHODS: This was a health records review of consecutive patients over a 3-month period presenting to two tertiary EDs and discharged with a diagnosis of primary headache. The primary outcome was the need for second round medications, defined as medications received > 1 h after the initial physician-ordered medications were administered. We performed multivariate logistic regression analysis to determine treatment factors associated with need for second round medications. RESULTS: We included 553 patients, mean age was 42.2 years and 72.9% were females. The most common diagnoses were headache not otherwise specified (48.8%) and migraine (43%). Ketorolac IV (62.2%) and metoclopramide IV (70.2%) were the most frequently administered medications. 18% of patients met the primary outcome. Dopamine antagonists (OR 0.3 [95% CI 0.1-0.5]) and non-steroidal anti-inflammatory drugs (NSAIDs) (OR 0.5 [95% CI 0.3-0.8]) ordered with initial medications were associated with reduced need for second round medications. Intravenous fluid boluses ≥ 500 ml (OR 2.8 [95% CI: 1.5-5.2]) and non-dopamine antagonist antiemetics (OR 2.2 [95% CI 1.2-4.2]) were associated with increased need. Opioid use approached statistical significance for receiving second round medication (p = 0.06). CONCLUSION: We determined that use of dopamine antagonists and NSAIDs were associated with a reduced need for second round medications in ED primary headache patients. Conversely, non-dopamine antagonist antiemetic medications and intravenous fluids were associated with a significantly increased need for second round medications. Careful choice of initial therapy may optimize management for these patients.
PURPOSE: We sought to evaluate the factors associated with better outcomes for emergency department (ED) patients treated for primary headache. METHODS: This was a health records review of consecutive patients over a 3-month period presenting to two tertiary EDs and discharged with a diagnosis of primary headache. The primary outcome was the need for second round medications, defined as medications received > 1 h after the initial physician-ordered medications were administered. We performed multivariate logistic regression analysis to determine treatment factors associated with need for second round medications. RESULTS: We included 553 patients, mean age was 42.2 years and 72.9% were females. The most common diagnoses were headache not otherwise specified (48.8%) and migraine (43%). Ketorolac IV (62.2%) and metoclopramide IV (70.2%) were the most frequently administered medications. 18% of patients met the primary outcome. Dopamine antagonists (OR 0.3 [95% CI 0.1-0.5]) and non-steroidal anti-inflammatory drugs (NSAIDs) (OR 0.5 [95% CI 0.3-0.8]) ordered with initial medications were associated with reduced need for second round medications. Intravenous fluid boluses ≥ 500 ml (OR 2.8 [95% CI: 1.5-5.2]) and non-dopamine antagonist antiemetics (OR 2.2 [95% CI 1.2-4.2]) were associated with increased need. Opioid use approached statistical significance for receiving second round medication (p = 0.06). CONCLUSION: We determined that use of dopamine antagonists and NSAIDs were associated with a reduced need for second round medications in ED primary headache patients. Conversely, non-dopamine antagonist antiemetic medications and intravenous fluids were associated with a significantly increased need for second round medications. Careful choice of initial therapy may optimize management for these patients.
Authors: Julie Munakata; Elisabeth Hazard; Daniel Serrano; David Klingman; Marcia F T Rupnow; Jonothan Tierce; Michael Reed; Richard B Lipton Journal: Headache Date: 2009-02-25 Impact factor: 5.887