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Stratification of risk for emergent intracranial abnormalities in children with headaches: a Pediatric Emergency Care Applied Research Network (PECARN) study protocol

INTRODUCTION: Headache is a common chief complaint of children presenting to emergency departments (EDs). Approximately 0.5%–1% will have emergent intracranial abnormalities (EIAs) such as brain tumours or strokes. However, more than one-third undergo emergent neuroimaging in the ED, resulting in a...

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Autores principales: Tsze, Daniel S, Kuppermann, Nathan, Casper, T Charles, Barney, Bradley J, Richer, Lawrence P, Liberman, Danica B, Okada, Pamela J, Morris, Claudia R, Myers, Sage R, Soung, Jane K, Mistry, Rakesh D, Babcock, Lynn, Spencer, Sandra P, Johnson, Michael D, Klein, Eileen J, Quayle, Kimberly S, Steele, Dale W, Cruz, Andrea T, Rogers, Alexander J, Thomas, Danny G, Grupp-Phelan, Jacqueline M, Johnson, Tiffani J, Dayan, Peter S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10668138/
https://www.ncbi.nlm.nih.gov/pubmed/37993148
http://dx.doi.org/10.1136/bmjopen-2023-079040
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author Tsze, Daniel S
Kuppermann, Nathan
Casper, T Charles
Barney, Bradley J
Richer, Lawrence P
Liberman, Danica B
Okada, Pamela J
Morris, Claudia R
Myers, Sage R
Soung, Jane K
Mistry, Rakesh D
Babcock, Lynn
Spencer, Sandra P
Johnson, Michael D
Klein, Eileen J
Quayle, Kimberly S
Steele, Dale W
Cruz, Andrea T
Rogers, Alexander J
Thomas, Danny G
Grupp-Phelan, Jacqueline M
Johnson, Tiffani J
Dayan, Peter S
author_facet Tsze, Daniel S
Kuppermann, Nathan
Casper, T Charles
Barney, Bradley J
Richer, Lawrence P
Liberman, Danica B
Okada, Pamela J
Morris, Claudia R
Myers, Sage R
Soung, Jane K
Mistry, Rakesh D
Babcock, Lynn
Spencer, Sandra P
Johnson, Michael D
Klein, Eileen J
Quayle, Kimberly S
Steele, Dale W
Cruz, Andrea T
Rogers, Alexander J
Thomas, Danny G
Grupp-Phelan, Jacqueline M
Johnson, Tiffani J
Dayan, Peter S
author_sort Tsze, Daniel S
collection PubMed
description INTRODUCTION: Headache is a common chief complaint of children presenting to emergency departments (EDs). Approximately 0.5%–1% will have emergent intracranial abnormalities (EIAs) such as brain tumours or strokes. However, more than one-third undergo emergent neuroimaging in the ED, resulting in a large number of children unnecessarily exposed to radiation. The overuse of neuroimaging in children with headaches in the ED is driven by clinician concern for life-threatening EIAs and lack of clarity regarding which clinical characteristics accurately identify children with EIAs. The study objective is to derive and internally validate a stratification model that accurately identifies the risk of EIA in children with headaches based on clinically sensible and reliable variables. METHODS AND ANALYSIS: Prospective cohort study of 28 000 children with headaches presenting to any of 18 EDs in the Pediatric Emergency Care Applied Research Network (PECARN). We include children aged 2–17 years with a chief complaint of headache. We exclude children with a clear non-intracranial alternative diagnosis, fever, neuroimaging within previous year, neurological or developmental condition such that patient history or physical examination may be unreliable, Glasgow Coma Scale score<14, intoxication, known pregnancy, history of intracranial surgery, known structural abnormality of the brain, pre-existing condition predisposing to an intracranial abnormality or intracranial hypertension, head injury within 14 days or not speaking English or Spanish. Clinicians complete a standardised history and physical examination of all eligible patients. Primary outcome is the presence of an EIA as determined by neuroimaging or clinical follow-up. We will use binary recursive partitioning and multiple regression analyses to create and internally validate the risk stratification model. ETHICS AND DISSEMINATION: Ethics approval was obtained for all participating sites from the University of Utah single Institutional Review Board. A waiver of informed consent was granted for collection of ED data. Verbal consent is obtained for follow-up contact. Results will be disseminated through international conferences, peer-reviewed publications, and open-access materials.
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spelling pubmed-106681382023-11-22 Stratification of risk for emergent intracranial abnormalities in children with headaches: a Pediatric Emergency Care Applied Research Network (PECARN) study protocol Tsze, Daniel S Kuppermann, Nathan Casper, T Charles Barney, Bradley J Richer, Lawrence P Liberman, Danica B Okada, Pamela J Morris, Claudia R Myers, Sage R Soung, Jane K Mistry, Rakesh D Babcock, Lynn Spencer, Sandra P Johnson, Michael D Klein, Eileen J Quayle, Kimberly S Steele, Dale W Cruz, Andrea T Rogers, Alexander J Thomas, Danny G Grupp-Phelan, Jacqueline M Johnson, Tiffani J Dayan, Peter S BMJ Open Paediatrics INTRODUCTION: Headache is a common chief complaint of children presenting to emergency departments (EDs). Approximately 0.5%–1% will have emergent intracranial abnormalities (EIAs) such as brain tumours or strokes. However, more than one-third undergo emergent neuroimaging in the ED, resulting in a large number of children unnecessarily exposed to radiation. The overuse of neuroimaging in children with headaches in the ED is driven by clinician concern for life-threatening EIAs and lack of clarity regarding which clinical characteristics accurately identify children with EIAs. The study objective is to derive and internally validate a stratification model that accurately identifies the risk of EIA in children with headaches based on clinically sensible and reliable variables. METHODS AND ANALYSIS: Prospective cohort study of 28 000 children with headaches presenting to any of 18 EDs in the Pediatric Emergency Care Applied Research Network (PECARN). We include children aged 2–17 years with a chief complaint of headache. We exclude children with a clear non-intracranial alternative diagnosis, fever, neuroimaging within previous year, neurological or developmental condition such that patient history or physical examination may be unreliable, Glasgow Coma Scale score<14, intoxication, known pregnancy, history of intracranial surgery, known structural abnormality of the brain, pre-existing condition predisposing to an intracranial abnormality or intracranial hypertension, head injury within 14 days or not speaking English or Spanish. Clinicians complete a standardised history and physical examination of all eligible patients. Primary outcome is the presence of an EIA as determined by neuroimaging or clinical follow-up. We will use binary recursive partitioning and multiple regression analyses to create and internally validate the risk stratification model. ETHICS AND DISSEMINATION: Ethics approval was obtained for all participating sites from the University of Utah single Institutional Review Board. A waiver of informed consent was granted for collection of ED data. Verbal consent is obtained for follow-up contact. Results will be disseminated through international conferences, peer-reviewed publications, and open-access materials. BMJ Publishing Group 2023-11-22 /pmc/articles/PMC10668138/ /pubmed/37993148 http://dx.doi.org/10.1136/bmjopen-2023-079040 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Paediatrics
Tsze, Daniel S
Kuppermann, Nathan
Casper, T Charles
Barney, Bradley J
Richer, Lawrence P
Liberman, Danica B
Okada, Pamela J
Morris, Claudia R
Myers, Sage R
Soung, Jane K
Mistry, Rakesh D
Babcock, Lynn
Spencer, Sandra P
Johnson, Michael D
Klein, Eileen J
Quayle, Kimberly S
Steele, Dale W
Cruz, Andrea T
Rogers, Alexander J
Thomas, Danny G
Grupp-Phelan, Jacqueline M
Johnson, Tiffani J
Dayan, Peter S
Stratification of risk for emergent intracranial abnormalities in children with headaches: a Pediatric Emergency Care Applied Research Network (PECARN) study protocol
title Stratification of risk for emergent intracranial abnormalities in children with headaches: a Pediatric Emergency Care Applied Research Network (PECARN) study protocol
title_full Stratification of risk for emergent intracranial abnormalities in children with headaches: a Pediatric Emergency Care Applied Research Network (PECARN) study protocol
title_fullStr Stratification of risk for emergent intracranial abnormalities in children with headaches: a Pediatric Emergency Care Applied Research Network (PECARN) study protocol
title_full_unstemmed Stratification of risk for emergent intracranial abnormalities in children with headaches: a Pediatric Emergency Care Applied Research Network (PECARN) study protocol
title_short Stratification of risk for emergent intracranial abnormalities in children with headaches: a Pediatric Emergency Care Applied Research Network (PECARN) study protocol
title_sort stratification of risk for emergent intracranial abnormalities in children with headaches: a pediatric emergency care applied research network (pecarn) study protocol
topic Paediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10668138/
https://www.ncbi.nlm.nih.gov/pubmed/37993148
http://dx.doi.org/10.1136/bmjopen-2023-079040
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