title: Headache in young children in the emergency department: use of computed tomography.
abstract: OBJECTIVE
  The goal was to determine whether computed tomographic (CT) scans led to better acute care of young children with headache presenting the emergency department (ED).
  
  
  METHODS
  We 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 examination findings, we first identified patients with secondary headaches (ie, 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 examination findings, laboratory and neuroimaging results, final diagnosis, and disposition.
  
  
  RESULTS
  On the basis of initial history and physical examination results, 306 children (84%) had secondary headaches. For 72% of those children, acute febrile illnesses and viral respiratory syndromes accounted for the headaches. Among the 58 children (16%) who had no recognized central nervous system disease or systemic illness at presentation, 28% had CT scans performed. Of those, 1 scan yielded abnormal results, showing a brainstem glioma; the patient demonstrated abnormal neurologic examination findings on the day of presentation. For 15 (94%) of 16 patients, the CT scans did not contribute to diagnosis or management. For 59% of children with apparently primary headaches, no family history was recorded.
  
  
  CONCLUSIONS
  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.
authors: Department of Neurology, Children's National Medical Center, George WashingtonUniversity School of Medicine, Washington, DC 20010, USA. tlateef@cnmc.org
authors: Tarannum M
authors: TM
authors: Lateef
authors: Mandeep
authors: M
authors: Grewal
authors: William
authors: W
authors: McClintock
authors: James
authors: J
authors: Chamberlain
authors: Himanshu
authors: H
authors: Kaulas
authors: Karin B
authors: KB
authors: Nelson
mesh_terms: D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006261:Headache / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008487:Medical History Taking; D009460:Neurologic Examination; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*