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Head Computed tomography during emergency department treat-and-release visit for headache is associated with increased risk of subsequent cerebrovascular disease hospitalization

  • Ava L. Liberman EMAIL logo , Cuiling Wang , Benjamin W. Friedman , Shyam Prabhakaran , Charles C. Esenwa , Sara K. Rostanski , Natalie T. Cheng , Amichai Erdfarb , Daniel L. Labovitz and Richard B. Lipton
Published/Copyright: October 5, 2020
Diagnosis
From the journal Diagnosis Volume 8 Issue 2

Abstract

Objectives

The occurrence of head computed tomography (HCT) at emergency department (ED) visit for non-specific neurological symptoms has been associated with increased subsequent stroke risk and may be a marker of diagnostic error. We evaluate whether HCT occurrence among ED headache patients is associated with increased subsequent cerebrovascular disease risk.

Methods

We conducted a retrospective cohort study of consecutive adult patients with headache who were discharged home from the ED (ED treat-and-release visit) at one multicenter institution. Patients with headache were defined as those with primary ICD-9/10-CM discharge diagnoses codes for benign headache from 9/1/2013-9/1/2018. The primary outcome of cerebrovascular disease hospitalization was identified using ICD-9/10-CM codes and confirmed via chart review. We matched headache patients who had a HCT (exposed) to those who did not have a HCT (unexposed) in the ED in a one-to-one fashion using propensity score methods.

Results

Among the 28,121 adult patients with ED treat-and-release headache visit, 45.6% (n=12,811) underwent HCT. A total of 0.4% (n=111) had a cerebrovascular hospitalization within 365 days of index visit. Using propensity score matching, 80.4% (n=10,296) of exposed patients were matched to unexposed. Exposed patients had increased risk of cerebrovascular hospitalization at 365 days (RR: 1.65: 95% CI: 1.18–2.31) and 180 days (RR: 1.62; 95% CI: 1.06–2.49); risk of cerebrovascular hospitalization was not increased at 90 or 30 days.

Conclusions

Having a HCT performed at ED treat-and-release headache visit is associated with increased risk of subsequent cerebrovascular disease. Future work to improve cerebrovascular disease prevention strategies in this subset of headache patients is warranted.

Keywords: cerebrovascular disease; emergency medicine; headache
Corresponding author: Ava L. Liberman, MD, Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, Bronx, NY 10467, USA, E-mail:

Funding source: NIH

Award Identifier / Grant number: K23NS107643

Funding source: NIH

Award Identifier / Grant number: 2PO1 AG003949, 5U10 NS077308, RO1 NS082432, 1RF1 AG057531, RF1 AG054548, 1RO1 AG048642, R56 AG057548

Funding source: Migraine Research Foundation

Funding source: National Headache Foundation

  1. Research funding: Dr. Liberman receives research support from NIH grant K23NS107643. Dr. Lipton receives research support from the NIH grants 2PO1 AG003949, 5U10 NS077308, RO1 NS082432, 1RF1 AG057531, RF1 AG054548, 1RO1 AG048642, R56 AG057548. Dr.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Dr. Lipton also receives support from the Migraine Research Foundation and the National Headache Foundation. He serves on the editorial board of Neurology, senior advisor to Headache, and associate editor to Cephalalgia. He has reviewed for the NIA and NINDS, holds stock options in eNeura Therapeutics and Biohaven Holdings; serves as consultant, advisory board member, or has received honoraria from: American Academy of Neurology, Alder, Allergan, American Headache Society, Amgen, Autonomic Technologies, Avanir, Biohaven, Biovision, Boston Scientific, Dr. Reddy’s, Electrocore, Eli Lilly, eNeura Therapeutics, GlaxoSmithKline, Merck, Pernix, Pfizer, Supernus, Teva, Trigemina, Vector, Vedanta. He receives royalties from Wolff’s Headache 7th and 8th Edition, Oxford Press University, 2009, Wiley and Informa. None of the authors have any other conflicts of interest to disclose.

  4. Ethical approval: The Institutional Review Board of MMC and the Albert Einstein College of Medicine approved this study and granted a waiver of consent.

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Supplementary Material

The online version of this article offers supplementary material https://doi.org/10.1515/dx-2020-0082.

Received: 2020-06-09
Accepted: 2020-08-14
Published Online: 2020-10-05
Published in Print: 2021-05-26

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/dx-2020-0082
Keywords for this article
cerebrovascular disease; emergency medicine; headache

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Machine learning in laboratory diagnostics: valuable resources or a big hoax?
  4. Review
  5. Diagnosis of mast cell activation syndrome: a global “consensus-2”
  6. Opinion Papers
  7. Re-thinking morbidity and mortality
  8. Improving diagnosis by feedback and deliberate practice: one-on-one coaching for diagnostic maturation
  9. Original Articles
  10. Using the NAM diagnostic process framework to teach clinical reasoning in computerized case presentations to 251 medical students
  11. The variability in how physicians think: a casebased diagnostic simulation exercise
  12. Missed acute myocardial infarction in the emergency department-standardizing measurement of misdiagnosis-related harms using the SPADE method
  13. Feasibility of patient-reported diagnostic errors following emergency department discharge: a pilot study
  14. An estimate of missed pediatric sepsis in the emergency department
  15. Head Computed tomography during emergency department treat-and-release visit for headache is associated with increased risk of subsequent cerebrovascular disease hospitalization
  16. A diagnostic time-out to improve differential diagnosis in pediatric abdominal pain
  17. Development of a rubric for assessing delayed diagnosis of appendicitis, diabetic ketoacidosis and sepsis
  18. Between Web search engines and artificial intelligence: what side is shown in laboratory tests?
  19. Impact of water temperature on reconstitution of quality controls for routine hemostasis testing
  20. Development of an algorithm for the identification of leukemic hematolymphoid neoplasms in Primary Care patients
  21. Establishing a stable platform for the measurement of blood endotoxin levels in the dialysis population
  22. Brazilian laboratory indicators benchmarking program: three-year experience on pre-analytical quality indicators
  23. The accuracy of nipple discharge cytology in detecting breast cancer
  24. Letter to the Editor
  25. Results of a hospital survey on critical values communication
  26. Online Only: Congress Abstracts
  27. The Diagnostic Error in Medicine 13th Annual International Conference
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