{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T02:07:41Z","timestamp":1784772461224,"version":"3.55.0"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,1,12]],"date-time":"2017-01-12T00:00:00Z","timestamp":1484179200000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001078","name":"Queensland Emergency Medicine Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001078","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The objective of this study was to describe demographic and clinical characteristics including features that were consistent with subarachnoid hemorrhage (<jats:styled-content style=\"fixed-case\">SAH<\/jats:styled-content>), use of diagnostic tests, emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>) discharge diagnoses, and disposition of adult patients presenting with an acute headache to <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>s statewide across Queensland, Australia. In addition, potential variations in the presentation and diagnostic workup between principal\u2010referral and city\u2010regional hospitals were examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospective cross\u2010sectional study was conducted over 4\u00a0weeks in September 2014. All patients \u2265 18 years presenting to one of 29 public and five private hospital <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>s across the state with an acute headache were included. The headache had to be the principal presenting complaint and nontraumatic. The 34 study sites attend to about 90% of all <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> presentations statewide. The treating doctor collected clinical information at the time of the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> visit including the characteristics of the headache and investigations performed. A study coordinator retrieved results of investigations, <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> discharge diagnoses, and disposition from state databases. Variations in presentation, investigations, and diagnosis between city\u2010regional and principal\u2010referral hospitals were examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 847 headache presentations. Median (range) age was 39 (18\u201392) years, 62% were female, and 31% arrived by ambulance. Headache peaked instantly in 18% and \u2264 1 hour in 44%. It was \u201cworst ever\u201d in 37%, 10\/10 in severity in 23%, and associated with physical activity in 7.4%. Glasgow Coma Scale score was\u00a0&lt;\u00a015 in 4.1%. Neck stiffness was noted on examination in 4.8%. Neurologic deficit persisting in the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> was found in 6.5%. A computed tomography (<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>) head scan was performed in 38% (318\/841, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> = 35% to 41%) and an lumbar puncture in 4.7% (39\/832, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0= 3.4% to 6.3%). There were 18 <jats:styled-content style=\"fixed-case\">SAH<\/jats:styled-content>, six intraparenchymal hemorrhages, one subdural hematoma, one newly diagnosed brain metastasis, and two bacterial meningitis. Migraine was diagnosed in 23% and \u201cprimary headache not further specified\u201d in 45%. <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> head scans were more likely to be performed in principal\u2010referral hospitals (41%) compared to city\u2010regional hospitals (33%). The headache in patients presenting to the latter was less likely to be instantly peaking or associated with activity, but was no less severe in intensity and was more frequently accompanied by nausea and vomiting. Their diagnosis was more likely to be a benign primary headache. Variations in <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> scanning could thus be due to differences in the case mix. The median (interquartile range) <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> length of stay was 3.1 (2.2 to 4.5) hours. Patients was discharged from the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> or admitted to the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> short\u2010stay unit prior to discharge in 57 and 23% of cases, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The majority of patients had a benign diagnosis, with intracranial hemorrhage and bacterial meningitis accounting for only 3% of the diagnoses. There are variations in the proportion of patients receiving <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> head scans between city\u2010regional and principal\u2010referral hospitals. As 38% of headache presentations overall underwent <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> scanning, there is scope to rationalize diagnostic testing to rule out life\u2010threatening conditions.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13062","type":"journal-article","created":{"date-parts":[[2017,1,13]],"date-time":"2017-01-13T11:45:20Z","timestamp":1484307920000},"page":"53-62","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Acute Headache Presentations to the Emergency Department: A Statewide Cross\u2010sectional Study"],"prefix":"10.1111","volume":"24","author":[{"given":"Kevin H.","family":"Chu","sequence":"first","affiliation":[{"name":"School of Medicine University of Queensland Herston Queensland Australia"},{"name":"Department of Emergency Medicine Royal Brisbane and Women's Hospital Herston Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tegwen E.","family":"Howell","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Royal Brisbane and Women's Hospital Herston Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerben","family":"Keijzers","sequence":"additional","affiliation":[{"name":"School of Medicine Griffith University Nathan Queensland Australia"},{"name":"School of Medicine Bond University Gold Coast Queensland Australia"},{"name":"Department of Emergency Medicine Gold Coast University Hospital Gold Coast Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy S.","family":"Furyk","sequence":"additional","affiliation":[{"name":"College of Medicine and Dentistry James Cook University Townsville Queensland Australia"},{"name":"Department of Emergency Medicine The Townsville Hospital Townsville Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Eley","sequence":"additional","affiliation":[{"name":"School of Medicine University of Queensland Herston Queensland Australia"},{"name":"Department of Emergency Medicine Princess Alexandra Hospital Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frances B.","family":"Kinnear","sequence":"additional","affiliation":[{"name":"School of Medicine University of Queensland Herston Queensland Australia"},{"name":"Department of Emergency Medicine The Prince Charles Hospital Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ogilvie","family":"Thom","sequence":"additional","affiliation":[{"name":"School of Medicine University of Queensland Herston Queensland Australia"},{"name":"Department of Emergency Medicine Nambour General Hospital Nambour Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Mahmoud","sequence":"additional","affiliation":[{"name":"School of Medicine University of Queensland Herston Queensland Australia"},{"name":"Department of Emergency Medicine Royal Brisbane and Women's Hospital Herston Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony F. 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