Quality standard

Quality statement 1: Headaches and 'red flag' symptoms in children

Quality statement 1: Headaches and 'red flag' symptoms in children

Quality statement

Children under 12 years with headache and 'red flag' symptoms are referred immediately for neurological assessment.

Rationale

Children aged under 12 years who present with headache may also have one or more 'red flag' symptoms. These children need to be seen by a specialist service within a few hours, or even more quickly if necessary, to diagnose or rule out significant intracranial pathology such as a brain tumour. Immediate referral and assessment will allow the appropriate treatment, including medical or surgical management, to be initiated to minimise morbidity and mortality.

Quality measures

Structure

a) Evidence of written clinical protocols to ensure that 'red flag' symptoms are recognised in children under 12 years presenting with headache.

Data source: Local data collection, for example checklists of symptoms.

b) Evidence of written clinical protocols to ensure that children under 12 years with headache and one or more 'red flag' symptoms are referred for neurological assessment immediately.

Data source: Local data collection, for example referral pathways.

Process

Proportion of children under 12 years with headache and one or more 'red flag' symptoms who are referred for same-day neurological assessment.

Numerator – The number in the denominator who are referred for same-day neurological assessment.

Denominator – The number of children under 12 years with headache and one or more 'red flag' symptoms.

Data source: Local data collection, for example local audit of patient records.

Outcome

Mortality rates from intracranial pathology in children under 12 years.

Data source: Local data collection, for example local audit of patient records.

What the quality statement means for different audiences

Service providers (such as primary care services, secondary care services and neurology departments) work together to ensure that systems are in place for immediate referral to neurological services if a child under 12 years presents with headache and one or more 'red flag' symptoms. They ensure that healthcare professionals are able to recognise the 'red flag' symptoms.

Healthcare professionals (such as GPs, neurology specialists and nurses) are aware of local referral pathways for children under 12 years who present with headache and one or more 'red flag' symptoms. They are aware of the 'red flag' symptoms and the requirement for immediate referral to neurological services for assessment.

Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission services for children under 12 years who present with headache and one or more 'red flag' symptoms to be referred immediately for neurological assessment. They ensure that local pathways for immediate referral are in place.

Children aged under 12 who develop headache together with certain other symptoms see a specialist within a few hours, or more quickly if necessary, to check for serious illness.

Definitions of terms used in this quality statement

'Red flag' symptoms

Any one of the following:

  • headache that wakes them at night

  • headache that is present on awakening in the morning

  • headache that progressively worsens

  • headache triggered or aggravated by coughing, sneezing or bending down

  • headache with fever and features of meningism

  • headache associated with vomiting

  • headache associated with ataxia (disorders that affect co-ordination, balance and speech)

  • headache associated with change in conscious level or pervasive lethargy

  • headache occurring within 5 days of a head injury

  • headache associated with squint or failure of upward gaze ('sunsetting').

[NICE's guideline on suspected neurological conditions: recognition and referral, recommendation 1.21.1]

Refer immediately

To be seen by the specialist service within a few hours, or even more quickly if necessary. [NICE's guideline on suspected neurological conditions: recognition and referral, terms used in this guideline]