Headache in Young Children in the Emergency Department: Use of Computed Tomography

Lateef, Tarannum; Grewal, Manpreet Kaur; McClintock, W.; Chamberlain, James M.; Kaulas, Himanshu; Nelson, Karin B.

doi:10.1542/peds.2008-3150

Cited by 51 publications

(46 citation statements)

References 25 publications

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“…Most of the time, one can ferret out who has tumor, bleed, or other serious secondary headache disorder from those with exacerbation of migraine or chronic daily headache. We therefore do not advocate routine ER imaging for those patients at low risk for secondary headache when they present …”

Section: Er and Inpatient Managementmentioning

confidence: 99%

“…We therefore do not advocate routine ER imaging for those patients at low risk for secondary headache when they present. 72 There have been multiple papers describing successful approaches to treatment of status migraine in both the emergency setting, as well as the inpatient setting. 73,74 Careful sequential use of medications used in the adult setting has been tried in children without a systemic prospective study.…”

Section: Er and Inpatient Managementmentioning

confidence: 99%

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Pediatric Headache: Where Have We Been and Where Do We Need to Be

2014

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Section: Er and Inpatient Managementmentioning

confidence: 99%

Section: Er and Inpatient Managementmentioning

confidence: 99%

Pediatric Headache: Where Have We Been and Where Do We Need to Be

2014

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“…1,4 Thus, neuroimaging is considered unnecessary in the diagnosis of headache when no other neurologic symptoms are present to suggest serious intracranial pathology. 1,[5][6][7][8][9][10][11][12][13] Not only is neuroimaging clinically unnecessary for children with isolated headache, it is also associated with potential long-term health risks. CT scans involve larger doses of radiation than conventional radiographs 14 and have been proposed to increase a child' s lifetime risk of cancer.…”

mentioning

confidence: 99%

“…This study resulted from this advisory group' s initial questions. Previous analyses examined neuroimaging as a diagnostic tool for children with headache, but those studies were performed in pediatric neurology clinics, 7,8,11,13,21 EDs, 3,5,22,23 or an ambulatory care setting. 10 This large-scale retrospective claims analysis sought to determine current, real-world practice patterns in the use of neuroimaging to diagnose pediatric headache.…”

mentioning

confidence: 99%

CT Scan Utilization Patterns in Pediatric Patients With Recurrent Headache

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Although unnecessary for children with headache and normal history, computed tomography (CT) scans are widely used. Fewer than 1% of pediatric brain abnormalities present with headache as the only symptom. Furthermore, repeated CT scans may increase lifetime risk of cancer.WHAT THIS STUDY ADDS: CT scans continue to be used to diagnose isolated pediatric headaches despite existing practice parameters. Although emergency department visits were correlated with greater likelihood of CT scan use, these scans were widely used across a variety of clinical settings. abstract OBJECTIVE: Although unnecessary for children with headache and normal history, computed tomography (CT) scans are widely used. This study sought to determine current practice patterns of neuroimaging to diagnose pediatric headache in a variety of treatment settings and to identify factors associated with increased use of neuroimaging. METHODS:This retrospective claims analysis included children (aged 3-17 years) with $2 medical claims for headache. The primary outcome was CT scan utilization on or after first presentation with headache in a physician' s office or emergency department (ED). RESULTS:Of 15 836 patients, 26% (4034 patients; mean age: 11.8 years) had $1 CT scan, 74% within 1 month of index diagnosis. Patients with ED visits were 4 times more likely to undergo a CT scan versus those without ED visits (P , .001 [95% confidence interval: 3.9-4.8]). However, even outside the ED, use of CT scans remained widespread. Two-thirds of patients with CT scans had no ED use. Among patients with no ED utilization, .20% received a CT scan during the study period. Evaluation by a neurologist was strongly associated with a lower likelihood of CT scan compared with other provider specialties (odds ratio: 0.37; P , .01 [95% confidence interval: 0.30-0.46]).CONCLUSIONS: Use of CT scans to diagnose pediatric headache remains high despite existing guidelines, low diagnostic yield, and high potential risk. Implementing quality improvement initiatives to ensure that CT scans in children are performed only when truly indicated will reduce unnecessary exposure to ionizing radiation and associated cancer risks. Pediatrics 2013;132:e1-e8 AUTHORS:

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“…It was found that for young children presenting with headache but normal neurological examination and non-worrying history, CT scans seldom lead to diagnosis or contribute to immediate management. 9 The use of CT scanning in young children should be done very carefully to avoid the hazardous exposure to radiation at a young age.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of CT Scan Findings In Patients Presenting With Headache

2014

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Headache is one of the most common medical complaint however, the secondary causes of headache are unusual. Neuroimaging in headache is both expensive and has a low yield. Most patients with intracranial pathology have alarming clinical features raising " red flag" signs. Thus appropriate selection of patients with headache for neuroimaging to look for secondary cause is important. Red flags act as screening tool to help in identifying those who get benefit from neuroimaging. These steps not only increase yield, but also limit cost as well as burden in health care system. The aim of our study was to evaluate all the CT scan findings in patients presenting with headache in Chitwan Medical College who underwent CT scan of head from February 2013 to September 2013 for period of seven months. Prospective observational study was performed in 256 patients, who underwent CT scan of head in this duration. Out of 256 patients, only 26 patients (10.1%) showed some form of brain parenchymal pathology. Other associated findings were sinusitis in 28 (11%), bone related in 10 (3.9%), and mastoiditis in 6 (2.3%) patients. The most prevalent pathology found was sinusitis, which was located in the maxillary sinus. The findings were significant in headache associated with other neurological findings, 16 out of 24 patients (67%) as compared to chronic headache in which only 10 cases out of 232 (4.3%) patients were positive (p<0.05). Cases referred from neurosurgery department and emergency yielded more positive results as compared to case referred from other outpatient departments.

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Headache in Young Children in the Emergency Department: Use of Computed Tomography

Abstract: For young children presenting to the ED with headache but normal neurologic examination findings and nonworrying history, CT scans seldom lead to diagnosis or contribute to immediate management.

Cited by 51 publications

References 25 publications

Pediatric Headache: Where Have We Been and Where Do We Need to Be

Pediatric Headache: Where Have We Been and Where Do We Need to Be

CT Scan Utilization Patterns in Pediatric Patients With Recurrent Headache

Evaluation of CT Scan Findings In Patients Presenting With Headache

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