Computed Tomography Scans Still Common in Pediatric Headache Evaluation

Despite current practice guidelines, CT scans are still ordered in emergency departments and pediatric practices.

The American Academy of Pediatrics, among other professional societies, recommends against the use of computed tomography (CT) scans in the evaluation of childhood headache. To determine the frequency of CT scans used to diagnose pediatric headache, investigators retrospectively analyzed U.S. insurance claims data for 15,836 children (age range, 3–17 years) with at least two claims for headaches in 2007 through 2008.

CT scans were performed in 25% of the children, typically in the month following the initial evaluation. The initial diagnostic categorization of the type of headache did not appear to influence whether CT was ordered, and the pre- and post-CT diagnostic headache category did not change for most patients. Among practitioners, neurologists were less likely and family practitioners were more likely to order CT scans. Evaluation in an emergency department (ED) increased the likelihood of CT evaluation for headache; however, two thirds of the children who underwent CT scans in this cohort had not been evaluated in an ED for headache

Comment

Radiation from computed tomography increases risk for cancer in children (NEJM JW Pediatr Adolesc Med Jul 2 2013). CT scans are seldom helpful or necessary in the evaluation of children with headache; by limiting CT scans for evaluation of childhood headache, we can make a large contribution to efforts to reduce radiation exposure by eliminating unnecessary CT scans.

Reviewing Author

F. Bruder Stapleton, MD

Disclosures

Consultant/Advisory BoardCareer Physician

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Leadership Positions in Professional SocietiesAmerican Society of Pediatric Nephrology Foundation (Chair)