Patel, Rahul

Aim To determine whether there is a difference in the time to complete a rapid number naming task during the interictal state compared to prodrome, migraine headache, postdrome phases of migraine and non-migraine headache, and characterize non-headache symptoms experienced during these phases. Methods This prospective longitudinal cohort study evaluated 30 adults with migraine with or without aura who completed diary entries and a timed rapid number naming task at least three times daily for up to four months from October 2020 to July 2022 at a tertiary headache center. Diary entries included self-report of current migraine phase (having a migraine headache, non-migraine headache, prodrome, postdrome, or interictal baseline) and detailed symptoms experienced. The outcome of interest for the timed rapid number naming task was the time to complete the task with zero errors. Results Compared to the interictal baseline, the time with zero errors for the rapid number naming task was significantly slower during the prodrome (median (Q1, Q3) 1.0 s slower (0.4, 2.9), p -value 0.010), migraine headache (median (Q1, Q3) 3.8 s slower (2.6, 7.5), p -value <0.001), and postdrome (median (Q1, Q3) 0.9 s slower (0.2, 2.1), p -value 0.011) phases of migraine, and non-migraine headache attacks (median (Q1, Q3) 1.2 s slower (0.1, 3.1), p -value 0.006). For those with migraine with aura (N = 15), the time with zero errors was significantly slower during all phases compared to interictal phase. For those with migraine without aura (N = 15), the time with zero errors was significantly slower only during the migraine headache, but not other phases compared to the interictal phase. The top 5 most reported non-headache symptoms during any phase of migraine and non-migraine headache attacks included fatigue, neck stiffness, light sensitivity, blurred vision/vision changes, and difficulty concentrating. Conclusions Among the overall participant cohort, the time with zero errors to complete a rapid number naming task was significantly slower during all ictal phases compared to interictal phase. This was also the case in the migraine with aura cohort but in the migraine without aura cohort there was only a significant difference during the migraine headache phase versus interictal phase. There is overlap in non-headache symptoms between the prodrome, migraine headache, postdrome, and non-migraine headache phases, which may make distinguishing between these phases difficult. Combining subjective data, such as symptom diaries, with objective measures, such as rapid number naming tasks, may allow for more refined assessment of migraine phases and distinguishing migraine from non-migraine headache attacks.

Introduction Teleneonatology (TN) allows neonatologists to use real-time, audio–video telemedicine to manage critically ill neonates located in community hospitals (CHs). The California Transport Risk Index of Physiologic Stability (Ca-TRIPS) score is a validated metric that predicts the risk of 7-day mortality for neonates undergoing medical transport. We hypothesized that neonates born in CHs who received TN consults would have lower (better) Ca-TRIPS scores upon arrival of the transport team than those who did not. Methods Neonates born in CHs between 8 December 2018 and 31 July 2022 who were transported to the neonatal intensive care unit were screened for eligibility. TN was available at 50% (12/24) of CHs, where care teams decided when to activate the service. Study data were abstracted from the electronic health record and used to calculate Ca-TRIPS scores. Scores were evaluated using zero-inflated negative binomial regression. Results Forty-two percent (161/385) of neonates received a TN consult. Neonates that received TN had lower birth weight, gestational age, and Apgar scores and were more often admitted with respiratory distress syndrome and respiratory failure. Neonates who received TN were less likely to have a Ca-TRIPS score of zero (odds ratio 0.51; 95% confidence interval 0.33, 0.78). When adjusted for baseline characteristics, this difference was no longer significant. Non-zero Ca-TRIPS scores were not different between groups. Discussion In this observational study, neonates that received TN did not have lower (better) Ca-TRIPS scores. Findings may be limited by confounding bias given between-group differences in baseline patient characteristics. Randomized studies are needed to determine whether TN impacts the physiologic stability of neonates requiring medical transport.