Attitudes and Judgment of Emergency Physicians in the Management of Patients with Acute Headache
Bibliographic record
Abstract
OBJECTIVES: There is little evidence guiding physicians in the evaluation of acute headache to rule out nontraumatic subarachnoid hemorrhage (SAH). The authors assessed emergency physicians in: 1) their pretest accuracy for predicting SAH, 2) their comfort with not ordering either head computed tomography (CT) or lumbar puncture (LP) in patients with acute headache, and 3) their comfort with not ordering head CT before performing LP in patients with acute headache. METHODS: This two-and-a-half-year prospective cohort study was conducted in three tertiary care university emergency departments with 51 emergency physicians. Consecutive patients more than 15 years of age with a nontraumatic, acute headache (onset to peak headache less than one hour) and normal results on neurologic examination were enrolled. Patients known to have cerebrospinal fluid shunt, aneurysm, or brain neoplasm, and patients with recurrent headaches of the same intensity/character as their current headache were excluded. Physicians recorded their pretest probability for SAH and their comfort with performing either no tests or an LP without first obtaining head CT. RESULTS: The authors enrolled 747 patients (mean age 42.8 years; 60.1% female; 77.0% their worst headache; 83.4% had CT and/or LP), including 50 (6.7%) with SAHs. Physicians reported being "uncomfortable" or "very uncomfortable" with performing no test in 75.4% of cases and being "uncomfortable" or "very uncomfortable" with performing LP without CT in 49.6% of cases. The area under the receiver operating characteristic (ROC) curve for SAH was 0.85 (95% CI = 0.80 to 0.91). CONCLUSIONS: Physicians were able to moderately discriminate SAH from other causes of headache before diagnostic testing.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.034 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".