Objectives. To describe a method for quantifying headache symptoms/features in family practice charts for patients diagnosed with headache NOS (not otherwis e specified, IGD 9: 784) and to determine the share of NOS h...Objectives. To describe a method for quantifying headache symptoms/features in family practice charts for patients diagnosed with headache NOS (not otherwis e specified, IGD 9: 784) and to determine the share of NOS headache diagnoses w ith clinical data strongly suggestive of migraine or probable migraine headache. Background. Headache is one of the most common pain symptoms that brings pati ents to a family physician. However, the majority of headache sufferers do not r eceive a specific headache diagnosis when they visit physicians. Methods. We e xamined the chart notes of 454 patients exclusively diagnosed with one or more I CD 9 coded headache NOS diagnoses from July 1, 1995 through December 31,1999 at a large suburban, university affiliated practice. We developed a template cont aining 20 headache items combining International Headache Society diagnostic cri teria and additional headache symptoms/features, and decision rules for coding s ymptom s/features and collected data from patient charts. We then developed dec ision rules and reclassified NOS headaches into categories strongly suggestive o f migraine, probable migraine headache, or other diagnosis. Our main outcome mea sure is the consistency in the application of decision rules and diagnostic crit eria. Results. With this method we estimate 3 in 10 (29%) headache NOS patien ts may have had migraine (8%) or probable migraine headache (21%). Reclassifi ed migraine visits averaged 6.5 migraine symptoms and reclassified probable migr aine headache visits 4.7 migraine symptoms. Logistic regression analysis support s the consistency of diagnostic criteria for classifying headache based on coded symptoms/features our model correctly predicted 96%of visits. Evidence of ph ysical examination was recorded at 75%of visits suggesting that physician atten tion is focused on elimination of secondary headache. Conclusions. We think th e use of our rigorous procedures reveals that a substantial amount of migraine a nd probable migraine headache may be missed in everyday practice. We hope our fi ndings will provide a basis for the development of diagnostic methods more close ly suited to the needs of nonspecialists, and contribute to a better standard of care for headache patients seen in primary care practice. Finally, we are hopef ul that other researchers will consider using our template and guideline procedu res in their efforts to identify diagnostic patterns and study headache and othe r health problems.展开更多
文摘Objectives. To describe a method for quantifying headache symptoms/features in family practice charts for patients diagnosed with headache NOS (not otherwis e specified, IGD 9: 784) and to determine the share of NOS headache diagnoses w ith clinical data strongly suggestive of migraine or probable migraine headache. Background. Headache is one of the most common pain symptoms that brings pati ents to a family physician. However, the majority of headache sufferers do not r eceive a specific headache diagnosis when they visit physicians. Methods. We e xamined the chart notes of 454 patients exclusively diagnosed with one or more I CD 9 coded headache NOS diagnoses from July 1, 1995 through December 31,1999 at a large suburban, university affiliated practice. We developed a template cont aining 20 headache items combining International Headache Society diagnostic cri teria and additional headache symptoms/features, and decision rules for coding s ymptom s/features and collected data from patient charts. We then developed dec ision rules and reclassified NOS headaches into categories strongly suggestive o f migraine, probable migraine headache, or other diagnosis. Our main outcome mea sure is the consistency in the application of decision rules and diagnostic crit eria. Results. With this method we estimate 3 in 10 (29%) headache NOS patien ts may have had migraine (8%) or probable migraine headache (21%). Reclassifi ed migraine visits averaged 6.5 migraine symptoms and reclassified probable migr aine headache visits 4.7 migraine symptoms. Logistic regression analysis support s the consistency of diagnostic criteria for classifying headache based on coded symptoms/features our model correctly predicted 96%of visits. Evidence of ph ysical examination was recorded at 75%of visits suggesting that physician atten tion is focused on elimination of secondary headache. Conclusions. We think th e use of our rigorous procedures reveals that a substantial amount of migraine a nd probable migraine headache may be missed in everyday practice. We hope our fi ndings will provide a basis for the development of diagnostic methods more close ly suited to the needs of nonspecialists, and contribute to a better standard of care for headache patients seen in primary care practice. Finally, we are hopef ul that other researchers will consider using our template and guideline procedu res in their efforts to identify diagnostic patterns and study headache and othe r health problems.
