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Early analgesic administration and headache presence 7 days post-concussion in children
Canadian Journal of Emergency Medicine ( IF 2.4 ) Pub Date : 2022-09-15 , DOI: 10.1007/s43678-022-00367-0
Andrée -Anne Ledoux 1, 2 , Ken Tang 1 , Stephen B Freedman 3 , Jocelyn Gravel 4 , Kathy Boutis 5 , Keith O Yeates 6 , Rebekah C Mannix 7 , Lawrence R Richer 8 , Michael J Bell 9 , Roger L Zemek 1, 10 ,
Affiliation  

Objective

This study investigates whether acute treatment with ibuprofen, acetaminophen, or both is associated with resolution of headache or reduction of headache pain at 7 days post-concussion in children and youth.

Methods

A secondary analysis of the Predicting and Preventing Post-concussive Problems in Pediatrics (5P) prospective cohort study was conducted. Individuals aged 5–18 years with acute concussion presenting to nine Canadian pediatric emergency departments (ED) were enrolled from August 2013 to June 2015. The primary outcome was the presence of headache at 7 days, measured using the Post-Concussion Symptom Inventory. The association between acute administration of ibuprofen, acetaminophen, or both and headache presence at 7 days was investigated with propensity scores and adjusted multivariate regression models.

Results

2277 (74.3%) of 3063 participants had headache upon ED presentation. Of these participants, 1543 (67.8%) received an analgesic medication before or during their ED visit [ibuprofen 754 (33.1%), acetaminophen 445 (19.5%), both 344 (15.1%); or no medication 734 (32.2%)]. Multivariate analysis pertained to 1707 participants with propensity scores based on personal characteristics and symptoms; 877 (51.4%) reported headache at 7 days post-concussion. No association emerged between treatment and presence of headache at 7 days [ibuprofen vs. untreated: (relative risk (RR) = 1.12 (95% CI 0.99,1.26); acetaminophen vs untreated RR = 1.02 (95% CI 0.87,1.22); both vs untreated RR = 1.02 (95% CI 0.86,1.18)].

Conclusions

Exposure to ibuprofen, acetaminophen, or both in the acute phase does not decrease the risk of headache at 7 days post-concussion. Non-opioid analgesics like ibuprofen or acetaminophen may be prescribed for short-term headache relief but clinicians need to be cautious with long-term medication overuse in those whose headache symptoms persist.



中文翻译:

儿童脑震荡后 7 天早期镇痛给药和头痛

客观的

本研究调查了儿童和青少年脑震荡后 7 天使用布洛芬、对乙酰氨基酚或两者的急性治疗是否与头痛缓解或头痛减轻有关。

方法

对预测和预防儿科脑震荡后问题 (5P) 前瞻性队列研究进行了二次分析。2013 年 8 月至 2015 年 6 月期间,5-18 岁的急性脑震荡患者被纳入九个加拿大儿科急诊科 (ED)。主要结果是 7 天时出现头痛,使用脑震荡后症状量表进行测量。使用倾向评分和调整后的多元回归模型研究布洛芬、对乙酰氨基酚或两者的急性给药与 7 天头痛之间的关联。

结果

3063 名参与者中有 2277 名 (74.3%) 在 ED 就诊时出现头痛。在这些参与者中,1543 (67.8%) 人在急诊就诊之前或期间接受了镇痛药 [布洛芬 754 (33.1%),对乙酰氨基酚 445 (19.5%),两者均为 344 (15.1%);或不服药 734 (32.2%)]。多变量分析涉及 1707 名参与者,其倾向得分基于个人特征和症状;877 (51.4%) 人在脑震荡后 7 天报告头痛。7 天时治疗与头痛之间没有关联 [布洛芬与未治疗:(相对风险 (RR) = 1.12 (95% CI 0.99,1.26);对乙酰氨基酚与未治疗 RR = 1.02 (95% CI 0.87,1.22);两者与未治疗的 RR = 1.02 (95% CI 0.86,1.18)]。

结论

在急性期接触布洛芬、对乙酰氨基酚或两者并不会降低脑震荡后 7 天头痛的风险。布洛芬或对乙酰氨基酚等非阿片类镇痛药可用于短期缓解头痛,但临床医生需要谨慎对待那些头痛症状持续存在的长期药物过度使用。

更新日期:2022-09-16
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