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


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).


CONCLUSIONS
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.
Ang
Seng Hock
SH
Department of Emergency Medicine, Changi General Hospital, Singapore. baileylove2002@yahoo.com
Chan
Yee Cheun
YC
Mahadevan
Malcolm
M
D004636:Emergency Service, Hospital; D006261:Headache / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology