title: Factors Associated With Discharge After Initial Emergency Treatment of Pediatric Migraine.
abstract: OBJECTIVE
  Migraine treatment varies widely in the pediatric emergency department (ED). Factors associated with discharge after only initial emergency treatment were examined.
  
  
  METHODS
  A retrospective chart analysis was conducted on patients 6 to 18 years old who presented to the St. Louis Children's Hospital ED between January 1, 2008, and December 31, 2011, with a discharge diagnosis of migraine (n = 700 visits). Associations between patient characteristics, initial treatments, and rates of discharge after only initial treatment were examined using a generalized linear model and receiver operating characteristic curves.
  
  
  RESULTS
  If exclusively oral or intranasal (PO/IN) medications were given initially (n = 285), ibuprofen alone was associated with lower discharge rates compared with other PO/IN medication regimens (P < 0.05). The only other variable associated with discharge was arrival pain score (P < 0.05). When ibuprofen alone was administered, pain scores equal to or lower than 5/10 were associated with the greatest sensitivity and specificity for discharge. With administration of other PO/IN regimens, pain scores equal to or lower than 8/10 were associated with the greatest sensitivity and specificity for discharge. If intravenous (IV) medications were given initially (n = 415), ketorolac given with an antinausea medication was associated with higher discharge rates compared with independent administration of these medications (P < 0.05). Intravenous medications were associated with higher discharge rates compared with PO/IN medications (P < 0.001).
  
  
  CONCLUSIONS
  Arrival pain score may be used to help select initial migraine treatment in the pediatric ED. Initial use of PO/IN regimens including triptans or an antiemetic and concurrent administration of IV ketorolac with an antiemetic may be associated with higher rates of discharge after initial treatment alone.
authors.affiliation: From the *St. Louis Children's Hospital; and Department of †Neurology, and ‡Pediatrics Washington University in St. Louis, St. Louis, MO.
authors.forename: Bhooma R
authors.initials: BR
authors.lastname: Aravamuthan
authors.forename: Soe Soe
authors.initials: SS
authors.lastname: Mar
authors.forename: Kristine G
authors.initials: KG
authors.lastname: Williams
mesh_terms: D000281:Administration, Intranasal; D061605:Administration, Intravenous; D000284:Administration, Oral; D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use; D002648:Child; D004636:Emergency Service, Hospital / Q000592:standards*; D004638:Emergency Treatment / Q000592:standards*; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage / Q000627:therapeutic use; D020910:Ketorolac / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008881:Migraine Disorders / Q000175:diagnosis* / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement / Q000187:drug effects; D010351:Patient Discharge / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000932:Antiemetics; D007052:Ibuprofen; D020910:Ketorolac