title: When to image neurologically normal children with headaches: development of a decision rule.
abstract: OBJECTIVE
  The aim of this study was to develop and refine a decision rule on when to undertake brain imaging (BI) in neurologically normal children with headaches.
  
  
  METHODS
  From the literature and a questionnaire study, a list of red flags (RFs) was drawn-up. During the prospective 4-year period, consecutive children with headache were classified according to RFs and the headache diagnosis.
  
  
  RESULTS
  Three of 709 (0.4%) neurologically normal children had significant brain abnormalities. BI was carried out in 389 of 498 (78%) children with RFs. Significant abnormalities were found in three of 389 children (0.8%), all had unclassified headache (UH). BI was not arranged for the 211 children with no RFs. None of these developed RFs or abnormal signs on follow-up for a mean of 13 months.
  
  
  CONCLUSIONS
  In addition to BI for those with neurological signs, we think BI should be considered for neurologically normal patients with UH and RFs. This would have saved imaging children needlessly: only 101 of 709 (14%) would have had scans arranged, instead of 389 of 709.
authors.affiliation: Paediatric Department, Queen's University Hospital, London, UK. mas.ahmed@bhrhospitals.nhs.uk
authors.forename: M A S
authors.initials: MA
authors.lastname: Ahmed
authors.forename: A
authors.initials: A
authors.lastname: Martinez
authors.forename: D
authors.initials: D
authors.lastname: Cahill
authors.forename: K
authors.initials: K
authors.lastname: Chong
authors.forename: W P
authors.initials: WP
authors.lastname: Whitehouse
mesh_terms: D000293:Adolescent; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000175:diagnosis*; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D011795:Surveys and Questionnaires