CT not helpful for ED pediatric headache presentation

For young children presenting to the emergency department (ED) with headache but normal neurologic exam findings and a non-worrying history, CT scans seldom lead to diagnosis or contribute to immediate management, according to a single-center study in the July issue of Pediatrics.

Tarannum M. Lateef, MD, and colleagues from the departments of neurology and emergency medicine at the Children's National Medical Center and George Washington University School of Medicine in Washington, D.C., examined the records of 364 children 2 to 5 years of age who presented with headache to a large urban ED between July 1, 2003, and June 30, 2006.

By reviewing initial history and exam findings, the researchers first identified patients with secondary headaches (i.e., with readily identifiable explanations, such as ventriculoperitoneal shunts, known brain tumors or acute illnesses, such as viral syndromes, fever, probable meningitis or trauma). Charts for the remaining patients were reviewed for headache history, neurologic exam findings, laboratory and neuroimaging results, final diagnosis and disposition.

On the basis of initial history and physical exam results, the investigators said that 306 children (84 percent) had secondary headaches. For 72 percent of those children, acute febrile illnesses and viral respiratory syndromes accounted for the headaches.

Among the 58 children who had no recognized central nervous system disease or systemic illness at presentation, 28 percent had CT scans performed. Of those, Lateef and colleagues reported that one scan yielded abnormal results, showing a brainstem glioma; the patient demonstrated abnormal neurologic examination findings on the day of presentation.

For 94 percent of the patients, the authors found that CT scans did not contribute to diagnosis or management. For 59 percent of children with apparently primary headaches, no family history was recorded.

The authors also noted concerns about high pediatric radiation exposure and expensive costs associated with CT procedures. At $1,361 per procedure, the investigators said that not only are CT scans unhelpful to this patient population in this setting, but also reinforces physicians in ordering more appropriate MRI exams.

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