Abstracts and Citations

Abstract

Headache neuroimaging: Routine testing when guidelines recommend against them. Cephalalgia. 2015 Feb 12 [Epub ahead of print].Aims: The aim of this article is to determine the patient-level factors associated with headache neuroimaging in outpatient practice.Methods: Using data from the 2007-2010 National Ambulatory Medical Care Surveys (NAMCS), we estimated headache neuroimaging utilization (cross-sectional). Multivariable logistic regression was used to explore associations between patient-level factors and neuroimaging utilization. A Markov model with Monte Carlo simulation was used to estimate neuroimaging utilization over time at the individual patient level.Results: Migraine diagnoses (OR = 0.6, 95% CI 0.4-0.9) and chronic headaches (routine, chronic OR = 0.3, 95% CI 0.2-0.6; flare-up, chronic OR = 0.5, 95% CI 0.3-0.96) were associated with lower utilization, but even in these populations neuroimaging was ordered frequently. Red flags for intracranial pathology did not increase use of neuroimaging studies (OR = 1.4, 95% CI 0.95-2.2). Neurologist visits (OR = 1.7, 95% CI 0.99-2.9) and first visits to a practice (OR = 3.2, 95% CI 1.4-7.4) were associated with increased imaging. A patient with new migraine headaches has a 39% (95% CI 24-54%) chance of receiving a neuroimaging study after 5 years, and a patient with a flare-up of chronic headaches has a 51% (32-68%) chance.Conclusions: Neuroimaging is routinely ordered in outpatient headache patients including populations where guidelines specifically recommend against their use (migraines, chronic headaches, no red flags). Gandhi R, Lewis EC, EvansJW, Sell E. Investigating the necessity of computed tomographic scans in children with headaches: A retrospective review. CJEM. 2015;17:148-153.Objective: Headaches are a common problem in the pediatric population. In 2002, the American Academy of Neurology (AAN) developed guidelines on neuroimaging for patients presenting with headache. Our objective was to determine the frequency of computed tomographic (CT) scanning ordered by a range of medical practitioners for pediatric patients presenting with primary headache.Methods: A retrospective chart review was conducted at the Children's Hospital of Eastern Ontario (CHEO), a tertiary care center in Ontario. One hundred fifty-one records of patients referred to the outpatient neurology clinic at CHEO with "headache" or "migraine" as the primary complaint from 2004 to 2009 were randomly selected. Ninety-nine patients with normal neurologic examinations were ultimately included.Results: Thirty-four patients (34%; 95% CI 25-45) had undergone CT scanning. None of the 34 CT scans (0%; 95% CI 0-10) showed significant findings, and none changed the headache diagnosis or management. Eleven (32%) of the CT scans were ordered by CHEO neurologists, 15 (44%) by community physicians, and 8 (24%) by CHEO emergency physicians.Conclusion: A high proportion of children presenting with primary headaches and a normal neurologic examination undergo CT scanning, despite well-established AAN...