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 l...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/11/e079040.full |
| _version_ | 1797429129813950464 |
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| author | Andrea T Cruz Rakesh D Mistry Nathan Kuppermann Sandra P Spencer Claudia R Morris Peter S Dayan T Charles Casper Alexander J Rogers Kimberly S Quayle Michael D Johnson Daniel S Tsze Bradley J Barney Lawrence P Richer Danica B Liberman Pamela J Okada Sage R Myers Jane K Soung Lynn Babcock Eileen J Klein Dale W Steele Danny G Thomas Jacqueline M Grupp-Phelan Tiffani J Johnson |
| author_facet | Andrea T Cruz Rakesh D Mistry Nathan Kuppermann Sandra P Spencer Claudia R Morris Peter S Dayan T Charles Casper Alexander J Rogers Kimberly S Quayle Michael D Johnson Daniel S Tsze Bradley J Barney Lawrence P Richer Danica B Liberman Pamela J Okada Sage R Myers Jane K Soung Lynn Babcock Eileen J Klein Dale W Steele Danny G Thomas Jacqueline M Grupp-Phelan Tiffani J Johnson |
| author_sort | Andrea T Cruz |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-03-09T09:08:46Z |
| format | Article |
| id | doaj.art-242a497bc7e440d09b185ca43106b230 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-09T09:08:46Z |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-242a497bc7e440d09b185ca43106b2302023-12-02T09:25:07ZengBMJ Publishing GroupBMJ Open2044-60552023-11-01131110.1136/bmjopen-2023-079040Stratification of risk for emergent intracranial abnormalities in children with headaches: a Pediatric Emergency Care Applied Research Network (PECARN) study protocolAndrea T Cruz0Rakesh D Mistry1Nathan Kuppermann2Sandra P Spencer3Claudia R Morris4Peter S Dayan5T Charles Casper6Alexander J Rogers7Kimberly S Quayle8Michael D Johnson9Daniel S Tsze10Bradley J Barney11Lawrence P Richer12Danica B Liberman13Pamela J Okada14Sage R Myers15Jane K Soung16Lynn Babcock17Eileen J Klein18Dale W Steele19Danny G Thomas20Jacqueline M Grupp-Phelan21Tiffani J Johnson22Department of Pediatrics, Divisions of Emergency Medicine & Infectious Diseases, Baylor College of Medicine, Houston, Texas, USADepartment of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USADepartments of Emergency Medicine and Pediatrics, University of California Davis School of Medicine, University of California Davis Health, Sacramento, California, USADepartment of Pediatrics, Division of Emergency Medicine, Ohio State University College of Medicine, Nationwide Children`s Hospital, Columbus, Ohio, USADepartment of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children`s Healthcare of Atlanta, Atlanta, Georgia, USADepartment of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USADepartment of Pediatrics, Division of Critical Care, University of Utah School of Medicine, Salt Lake City, Utah, USADepartments of Emergency Medicine and Pediatrics, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USADepartment of Pediatrics, Division of Pediatric Emergency Medicine, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USADepartment of Pediatrics, Division of Pediatric Emergency Medicine, The University of Utah School of Medicine, Salt Lake City, Utah, USADepartment of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USADepartment of Pediatrics, Division of Critical Care, University of Utah School of Medicine, Salt Lake City, Utah, USAWomen and Children`s Health Research Institute, Edmonton, Alberta, CanadaDepartments of Pediatrics and Population and Public Health Sciences, Division of Emergency and Transport Medicine, University of Southern California Keck School of Medicine, Children`s Hospital Los Angeles, Los Angeles, California, USADepartment of Pediatrics, Division of Pediatric Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USADepartment of Pediatrics, Division of Pediatric Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Children`s Hospital of Philadelphia, Philadelphia, Pennsylvania, USADepartment of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USADepartment of Pediatrics, Division of Emergency Medicine, University of Cincinnati, Cincinnati Children`s Hospital Medical Center, Cincinnati, Ohio, USADepartment of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle Children`s Hospital, Seattle, Washington, USADepartments of Emergency Medicine, Pediatrics and Health Services, Policy & Practice, Warren Alpert Medical School and School of Public Health of Brown University, Providence, Rhode Island, USADepartment of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USADepartment of Emergency Medicine, UCSF Benioff Children`s Hospital, San Francisco, California, USADepartments of Emergency Medicine and Pediatrics, University of California Davis School of Medicine, University of California Davis Health, Sacramento, California, USAIntroduction 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.https://bmjopen.bmj.com/content/13/11/e079040.full |
| spellingShingle | Andrea T Cruz Rakesh D Mistry Nathan Kuppermann Sandra P Spencer Claudia R Morris Peter S Dayan T Charles Casper Alexander J Rogers Kimberly S Quayle Michael D Johnson Daniel S Tsze Bradley J Barney Lawrence P Richer Danica B Liberman Pamela J Okada Sage R Myers Jane K Soung Lynn Babcock Eileen J Klein Dale W Steele Danny G Thomas Jacqueline M Grupp-Phelan Tiffani J Johnson Stratification of risk for emergent intracranial abnormalities in children with headaches: a Pediatric Emergency Care Applied Research Network (PECARN) study protocol BMJ Open |
| 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 |
| url | https://bmjopen.bmj.com/content/13/11/e079040.full |
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