The impact of pregnancy on headache evaluation in the emergency department, a retrospective cohort study

DOI: https://doi.org/10.1007/s10140-017-1497-3

Abstract-Summary There is no currently well-established guideline for diagnostic imaging with a com- mon concern being ionizing radiation exposure in pregnancy.

The purpose of this study was to assess the difference in imaging studies ordered for pregnant and non-pregnant patients who reported to a tertiary care emergency department with headache.

The purpose of this study was to assess the difference in imaging studies ordered for pregnant and non-pregnant patients who reported to a tertiary care emergency department with headache.

This retrospective cohort study identified all reproductive age female patients who presented to the emergency department with a chief complaint of “headache.” Rates and types of imaging studies utilized in patient evaluation were then

compared.

Our data shows a difference in evaluation for pregnant patients as compared to

their non-pregnant cohort.

The time difference, cost, fetal exposure risk, and availability of CT compared to MRI should be taken into account when establishing a criterion for diagnostic evaluation.

This difference validates the need for further research into a well-established guideline for the emergent evaluation of headache in the ED without special bias placed on pregnancy status.

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Extended: The purpose of this study is to compare the rates of imaging studies ordered in pregnant and non- pregnant patients who presented to the emergency department with a chief complaint of “headache.”

Introduction The differential diagnosis of headache in pregnant women includes primary head- aches, venous thromboembolism, pituitary apoplexy, and cerebral angiopathy [431]. Neuroimaging studies can reveal an underlying pathology in about 27% of preg-

nant patients with headaches [432].

In regard to evaluation of headache in pregnancy, the estimated fetal dose with computed tomography (CT) of the head is 0–10 mGy with more recent data report- ing head CT with an estimated 0 mGy exposure and CT PE protocol as 0.2 mGy [433, 434].

The radiation exposure risk is felt to be low enough that the American College of Radiology (ACR) states that any diagnostic examination of the head and neck should be performed as medically indicated regardless of pregnancy status [435].

The purpose of this study is to compare the rates of imaging studies ordered in pregnant and non-pregnant patients who presented to the emergency department with a chief complaint of “headache.”

Materials and methods This was a retrospective cohort study which examined female patients of reproduc- tive age who presented to the emergency department with a chief complaint docu- mented as “headache.”

Chief complaints, demographics, imaging studies, and patient disposition were

all extracted from this electronic record.

All female patients of reproductive age (18 to 52 years) who presented to an academic medical center emergency department over a 5-year period (2010–2015) were screened for inclusion in this study.

All female patients with a chief complaint of headache in the age range were

included in the study and stratified into cohorts based on pregnancy status.

It was felt that patients known to have these diagnoses are more likely to receive

imaging as compared to the general population studied.

Results In the pregnant cohort, head CTs were ordered significantly less than in the non- pregnant cohort (p < 0.0001; OR 4.21).

Head MRIs were also ordered significantly more in the pregnant cohort than in

the non-pregnant cohort (P = 0.0127; OR 0.49).

Total length of stay in the emergency department was equivalent between the not

pregnant and pregnant cohorts (4.9 vs. 4.7 h (P = 0.86)).

Discussion The objective of this study was to review the comparative rates of imaging studies between pregnant and non-pregnant female patients who presented with “headache” to the emergency department.

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This study has shown that there is a discrepancy in the evaluation of headache in pregnant and non-pregnant patients where pregnant patients were more likely to have a head MRI performed than a head CT scan.

Since the amount of radiation to the fetus imparted by a head CT is negligible and the teratogenic threshold is not effected, let alone approached [435–437], the evaluation of headache in pregnancy should be identical to that in non-pregnant patients.

This study demonstrates the discrepancy between evaluation of headache in

pregnant and non-pregnant patients in an emergent setting.

This highlights the need for clear consensus guidelines for the evaluation of headache patients in an emergent setting, regardless of pregnancy status, to ensure efficient diagnosis and timely management.

Acknowledgement A machine generated summary based on the work of Waldman, Ian; Wagner, Stephen; Posadas, Kristine; Deimling, Timothy A. 2017 in Emergency Radiology.

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