Estudio descriptivo de validez y aplicabilidad de la regla nemotécnica POUNDing en pacientes con migraña / Validity and applicability of the mnemonic POUNDing rule in patients with migraine. A descriptive study

INTRODUCCIÓN: En la valoración inicial de un paciente con cefalea, el médico se plantea con frecuencia si el dolor se corresponde con una migraña y si el paciente precisa pruebas de neuroimagen. El objetivo del trabajo fue valorar la validez y aplicabilidad de la regla nemotécnica POUNDing en pacientes diagnosticados de migraña. PACIENTES Y MÉTODOS: Estudio descriptivo, de aplicación de la regla POUNDing en pacientes con diagnóstico de migraña y con realización de alguna prueba de imagen cerebral (tomografía computarizada o resonancia magnética), en un centro de salud urbano y en una consulta de Neurología del Hospital Universitario de Badajoz. RESULTADOS: Se incluyó a 116 pacientes (edad media 45,6 años; 79,3% mujeres; 70 procedentes de consultas de Neurología y 46 del centro de salud). Destacaron en las comparaciones los elevados valores predictivos positivos: 90,9% (IC 95%: 57,1-99,5%); 100% (IC 95%: 73,2-99,3%) y 96,0% (IC 95%: 77,7-99,8%), en los pacientes de la consulta de Neurología, del centro de salud y en la población total, respectivamente, y sus bajos valores predictivos negativos: 6,8% (IC 95%: 2,2-17,3%); 3,1% (IC 95%: 0,2-18,0%) y 5,5% (IC 95%: 2,0-12,9%), también respectivamente en los pacientes de la consulta de Neurología, del centro de salud y en la población total. CONCLUSIONES: La regla POUNDing presenta un alto valor predictivo positivo y podría ser de gran ayuda en la aceptación o rechazo de un diagnóstico de migraña, al facilitar un uso más eficiente de las pruebas de neuroimagen

INTRODUCTION: In assessing the patient with headache, clinicians are often faced with 2 important questions: Is this headache a migraine? Does this patient require neuroimaging? The aim of this study was to assess the validity and applicability of the mnemonic POUNDing rule in patients diagnosed with migraine. PATIENTS AND METHODS: A descriptive, validation study of the POUNDing rule in patients with a diagnosis of migraines and with a brain imaging test (computed tomography or magnetic resonance imaging), in an urban health centre and a neurology clinic of the University Hospital of Badajoz. RESULTS: A total of 116 patients were included (mean age 45.6 years; 79.3% women, 70 from the neurology clinics, and 46 from the health centre). The best validity parameters of the POUNDing rule were its positive predictive values: 90.9% (95% CI: 57.1-99.5%), 100% (95% CI: 73.2-99.3%), and 96.0% (95% CI: 77.7-99.8%) in the patients of the neurology clinic, the health centre and in the total population, respectively, and its low negative predictive values: 6.8% (95% CI: 2.2-17.3%), 3.1% (95% CI: 0.2-18.0%), and 5.5% (95% CI: 2.0-12.9%), also respectively in the patients of the neurology clinic, the health centre and in the total population. CONCLUSIONS: The POUNDing mnemonic rule has a high positive predictive values and can be a great help in accepting or rejecting a diagnosis of migraine, facilitating a more efficient use of neuroimaging tests

[Validity and applicability of the mnemonic POUNDing rule in patients with migraine. A descriptive study]. / Estudio descriptivo de validez y aplicabilidad de la regla nemotécnica POUNDing en pacientes con migraña.

INTRODUCTION: In assessing the patient with headache, clinicians are often faced with 2 important questions: Is this headache a migraine? Does this patient require neuroimaging? The aim of this study was to assess the validity and applicability of the mnemonic POUNDing rule in patients diagnosed with migraine. PATIENTS AND METHODS: A descriptive, validation study of the POUNDing rule in patients with a diagnosis of migraines and with a brain imaging test (computed tomography or magnetic resonance imaging), in an urban health centre and a neurology clinic of the University Hospital of Badajoz. RESULTS: A total of 116 patients were included (mean age 45.6 years; 79.3% women, 70 from the neurology clinics, and 46 from the health centre). The best validity parameters of the POUNDing rule were its positive predictive values: 90.9% (95% CI: 57.1-99.5%), 100% (95% CI: 73.2-99.3%), and 96.0% (95% CI: 77.7-99.8%) in the patients of the neurology clinic, the health centre and in the total population, respectively, and its low negative predictive values: 6.8% (95% CI: 2.2-17.3%), 3.1% (95% CI: 0.2-18.0%), and 5.5% (95% CI: 2.0-12.9%), also respectively in the patients of the neurology clinic, the health centre and in the total population. CONCLUSIONS: The POUNDing mnemonic rule has a high positive predictive values and can be a great help in accepting or rejecting a diagnosis of migraine, facilitating a more efficient use of neuroimaging tests.

Stroke Awareness Is Worse among the Old and Poorly Educated: A Population-Based Survey.

BACKGROUND: This article surveys a representative sample of adults to assess their knowledge of stroke, its vascular risk factors and warning symptoms, illness perception, and attitude toward strokes. METHODS: A representative sample of the region population was selected using a double randomization design. Previously trained medical students carried out face-to-face interviews using a structured questionnaire with open- and closed-ended questions. RESULTS: In all, 2411 subjects were interviewed. Seventy-three percent reported at least 1 correct warning sign of stroke, whereas only 12.2% reported 3. The most frequently mentioned were sudden weakness, dizziness, and headache. Only 59.2% named at least 1 correct risk factor for stroke. Smoking and hypertension were mainly named. Forty percent of the respondents demonstrated adequate knowledge of stroke. Tellingly, prevalence of adequate knowledge was significantly lower in subjects with previous stroke (29.3% [95% confidence interval {CI}, 19.7-40.3], P = .049), hypertension (35.0% [95% CI, 31.1-39.1], P = .009), diabetes (31.9% [95% CI, 25.9-38.3], P = .011), hypercholesterolemia (35.8% [95% CI, 31.8-39.9], P = .03), and obesity (28.2% [95% CI, 23.8-33.0], P < .001). Illness perception was generally correct. In the final logistic regression model, younger age, urban area of residence, higher educational level, higher family income, normal pressure, normal weight, and family history of stroke were associated with adequate knowledge of stroke. CONCLUSIONS: Basic knowledge of stroke is insufficient among the general population of Extremadura. There is a discrepancy between theoretical stroke knowledge and illness perception. These findings have implications for public health initiatives for stroke.