TY - JOUR
T1 - The Headache in Emergency Departments study: Opioid prescribing in patients presenting with headache. A multicenter, cross-sectional, observational study
AU - Pellatt, Richard A.F.
AU - Kamona, Sinan
AU - Chu, Kevin
AU - Sweeny, Amy
AU - Kuan, Win Sen
AU - Kinnear, Frances B.
AU - Karamercan, Mehmet A.
AU - Klim, Sharon
AU - Wijeratne, Tissa
AU - Graham, Colin A.
AU - Body, Richard
AU - Roberts, Tom
AU - Horner, Daniel
AU - Laribi, Said
AU - Keijzers, Gerben
AU - Kelly, Anne Maree
N1 - Funding Information:
Royal College of Emergency Medicine (UK) provided partial funding HEAD Study Group: Catherine Lunter (Coffs Harbour Hospital, New South Wales, Australia), Rochelle Facer (Concord Repatriation Hospital, New South Wales, Australia), David Thomson (Port Macquarie Base and Kempsey District Hospitals, New South Wales, Australia), Robert Day (Royal North Shore Hospital, New South Wales, Australia), Greg McDonald (Sydney Adventist Hospital, New South Wales, Australia), Sarah Jones (Tamworth Regional Hospital, New South Wales, Australia), Julian Cochrane (Orange Base Hospital, New South Wales, Australia), Stephen Gourley (Alice Springs Hospital, Northern Territory, Australia), Mark Ross and Vinay Gangathimmaiah (Royal Darwin Hospital, Northern Territory, Australia), Kim Hansen (St Andrew?s War Memorial Hospital, Queensland, Australia), Frances B. Kinnear (The Prince Charles Hospital, Queensland, Australia), Gerben Keijzers (Gold Coast University Hospital, Queensland, Australia), Kevin Chu (Royal Brisbane and Women?s Hospital, Queensland, Australia), Paul Bowe (Robina Hospital, Queensland, Australia), Raymund de la Cruz (Lyell McEwin and Modbury Hospitals, South Australia, Australia), Daniel Haustead (The Queen Elizabeth and Royal Adelaide Hospitals, South Australia, Australia), Jean Moller (University Hospital Geelong, Victoria, Australia), Katie Walker (Cabrini Malvern, Victoria, Australia), Richard D. Smith (Bendigo Health, Victoria, Australia), Ron Sultana (Epworth Healthcare, Victoria, Australia), John Pasco (Werribee Mercy Hospital, Victoria, Australia), Neil Goldie and Andis Graudins (Monash Health, Victoria, Australia), Rosamond Dwyer (Peninsula Health, Victoria, Australia), George Plunkett (Melbourne Health, Victoria, Australia), Anne-Maree Kelly (Western Health, Victoria, Australia), Hugh Mitenko (WA Country Health Service, Western Australia), Michael Lovegrove (Joondalup Health Campus, Western Australia), Ben Smedley (Rockingham General Hospital, Western Australia), Colin A. Graham and Ling Yan Leung (Prince of Wales Hospital, Hong Kong SAR), Win Sen Kuan and Ying Wei Yau (National University Hospital, Singapore), Wei Ming Ng (Ng Teng Fong General Hospital, Singapore), Ranjeev Kumar (Khoo Teck Puat Hospital, Singapore), Dennis Wen Jie Chia (Sengkang General Hospital, Singapore), Said Laribi (CHU Tours, Tours, France), Mounir Hilal and Rarthtana Mil (CH Vend?me, France), Audrey Gerineau (CHR Orl?ans, France), Matthew J. Reed (Emergency Medicine Research Group Edinburgh [EMERGE], Royal Infirmary of Edinburgh, UK), Daniel Horner (Salford Royal NHS Foundation Trust, Salford, UK), Edward Carlton and Tom Roberts (North Bristol NHS Trust, UK), Girish Boggaram and Jayne Foot (Musgrove Park Hospital, Taunton, UK), Andy Appleboam, Rachel Goss and Hamza Malik (Royal Devon and Exeter NHS Foundation, UK), Richard Body (Manchester Royal Infirmary, Manchester, UK), John-Paul Williamson (Royal Oldham Hospital, Oldham, UK), Adela Golea and Sonia Luka (University County Hospital Cluj-Napoca, Romania), Huseyin Avni Demir (University of Health Sciences Mehmet Akif Inan Training and Research Hospital, Department of Emergency Medicine, ?anl?urfa Turkey), ?afak ?ner G?lpinar (Tokat Erbaa Government Hospital, Tokat, Turkey), Lale Tolu (Bursa ?ekirge Government Hospital of Emergency Service, Bursa, Turkey), Muhammet Hacimustafao?lu (Hakkari Yuksekova Government Hospital, Hakkari, Turkey), Mehmet A. Karamercan (Gazi University Faculty of Medicine Department of Emergency Medicine, Ankara, Turkey), Elif ?elikel (Numune Research and Training Hospital, Department of Emergency Medicine, Ankara, Turkey), ?ilem ?altili (Un?vers?ty of Health Sciences Ba?c?lar Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey), Selahattin G?r? (Y?ld?r?m Beyaz?t University Faculty of Medicine Department of Emergency Medicine, Ankara, Turkey), G?l?ah Yavuz (Antalya Ataturk Government Hospital of Medicine, Department of Emergency Medicine, Antalya, Turkey), Franck Verschuren (Institute of Experimental and Clinical Research, Emergency Department, Saint-Luc University Hospital, Brussels, Belgium), Christopher Ramos (Emergency Department, Saint-Luc University Hospital, Brussels, Belgium), Paule Denoel and Nicolas Wilmet (Saint Michel, Clinique de l'Europe, Etterbeek, Brussels), Michael Vandoorslaert and Alessandro Manara (Saint Elisabeth, Clinique de l'Europe, Uccle, Brussels), Adeline Higuet (CHR Hal, Belgium), Amichai Sheffy (Tel-Aviv Sourasky Medical Center, Israel), Sinan Kamona and Peter Jones (University of Auckland, School of Medicine, Auckland, New Zealand), Mai Nguyen (Wellington Hospital, Wellington, New Zealand), Anne Clarke (Hutt Valley Hospital, Lower Hutt, New Zealand), Sierra Beck (Dunedin Hospital, Dunedin, New Zealand), Andrew Munro (Nelson Hospital, Nelson, New Zealand), Kim M. Yates (North Shore and Waitakere Hospitals, Waitemat? District Health Board, New Zealand), James Weaver (Christchurch Hospital, Christchurch, New Zealand), Deborah Moore and Stuart Innes (Tauranga Hospital, Tauranga, New Zealand), Karina Walters (Taranaki District Health Board, New Zealand), and Koen Simons (Statistician, Office for Research, Western Health and University of Melbourne, Victoria, Australia). Steering Committee: Anne-Maree Kelly, Kevin Chu, Tissa Wijeratne, Frances B. Kinnear, Gerben Keijzers, Sinan Kamona, Win Sen Kuan, Colin Graham, Richard Body, Said Laribi, Sharon Klim, Mehmet Karamercan, Tom Roberts, and Daniel Horner. Co-ordinating Centre, Western Health, Victoria, Australia: Anne-Maree Kelly, Sharon Klim, and Kerrie Russell.
Publisher Copyright:
© 2021 American Headache Society
PY - 2021/10
Y1 - 2021/10
N2 - Objective: To describe the patterns of opioid use in patients presenting to the emergency department (ED) with nontraumatic headache by severity and geography. Background: International guidelines recognize opioids are ineffective in treating primary headache disorders. Globally, many countries are experiencing an opioid crisis. The ED can be a point of initial exposure leading to tolerance for patients. More geographically diverse data are required to inform practice. Methods: This was a planned, multicenter, cross-sectional, observational substudy of the international Headache in Emergency Departments (HEAD) study. Participants were prospectively identified throughout March 2019 from 67 hospitals in Europe, Asia, Australia, and New Zealand. Adult patients with nontraumatic headache were included as identified by the local site investigator. Results: Overall, 4536 patients were enrolled in the HEAD study. Opioids were administered in 1072/4536 (23.6%) patients in the ED, and 386/3792 (10.2%) of discharged patients. High opioid use occurred prehospital in Australia (190/1777, 10.7%) and New Zealand (55/593, 9.3%). Opioid use in the ED was highest in these countries (Australia: 586/1777, 33.0%; New Zealand: 221/593, 37.3%). Opioid prescription on discharge was highest in Singapore (125/442, 28.3%) and Hong Kong (12/49, 24.5%). Independent predictors of ED opioid administration included the following: severe headache (OR 4.2, 95% CI 3.1–5.5), pre-ED opioid use (OR 1.42, 95% CI 1.11–1.82), and long-term opioid use (OR 1.80, 95% CI 1.26–2.58). ED opioid administration independently predicted opioid prescription at discharge (OR 8.4, 95% CI 6.3–11.0). Conclusion: Opioid prescription for nontraumatic headache in the ED and on discharge varies internationally. Severe headache, prehospital opioid use, and long-term opioid use predicted ED opioid administration. ED opioid administration was a strong predictor of opioid prescription at discharge. These findings support education around policy and guidelines to ensure adherence to evidence-based interventions for headache.
AB - Objective: To describe the patterns of opioid use in patients presenting to the emergency department (ED) with nontraumatic headache by severity and geography. Background: International guidelines recognize opioids are ineffective in treating primary headache disorders. Globally, many countries are experiencing an opioid crisis. The ED can be a point of initial exposure leading to tolerance for patients. More geographically diverse data are required to inform practice. Methods: This was a planned, multicenter, cross-sectional, observational substudy of the international Headache in Emergency Departments (HEAD) study. Participants were prospectively identified throughout March 2019 from 67 hospitals in Europe, Asia, Australia, and New Zealand. Adult patients with nontraumatic headache were included as identified by the local site investigator. Results: Overall, 4536 patients were enrolled in the HEAD study. Opioids were administered in 1072/4536 (23.6%) patients in the ED, and 386/3792 (10.2%) of discharged patients. High opioid use occurred prehospital in Australia (190/1777, 10.7%) and New Zealand (55/593, 9.3%). Opioid use in the ED was highest in these countries (Australia: 586/1777, 33.0%; New Zealand: 221/593, 37.3%). Opioid prescription on discharge was highest in Singapore (125/442, 28.3%) and Hong Kong (12/49, 24.5%). Independent predictors of ED opioid administration included the following: severe headache (OR 4.2, 95% CI 3.1–5.5), pre-ED opioid use (OR 1.42, 95% CI 1.11–1.82), and long-term opioid use (OR 1.80, 95% CI 1.26–2.58). ED opioid administration independently predicted opioid prescription at discharge (OR 8.4, 95% CI 6.3–11.0). Conclusion: Opioid prescription for nontraumatic headache in the ED and on discharge varies internationally. Severe headache, prehospital opioid use, and long-term opioid use predicted ED opioid administration. ED opioid administration was a strong predictor of opioid prescription at discharge. These findings support education around policy and guidelines to ensure adherence to evidence-based interventions for headache.
UR - http://www.scopus.com/inward/record.url?scp=85116755807&partnerID=8YFLogxK
U2 - 10.1111/head.14217
DO - 10.1111/head.14217
M3 - Article
C2 - 34632592
AN - SCOPUS:85116755807
SN - 0017-8748
VL - 61
SP - 1387
EP - 1402
JO - Headache
JF - Headache
IS - 9
ER -