title: Findings of chronic sinusitis on brain computed tomography are not associated with acute headaches.
abstract: BACKGROUND
  Headache is a common complaint in emergency department (ED) patients. Nearly 15% of ED headache patients will have brain computed tomography (CT) done. One frequent finding on these scans is "chronic sinusitis." Assuming that "chronic sinusitis" is the cause of the patient's headache is a potential source of mis-diagnosis.
  
  
  OBJECTIVE
  We hypothesized that CT findings of chronic sinusitis occur with equal frequency in patients with atraumatic headache as in control patients with minor head injury.
  
  
  METHODS
  This is a retrospective, single-center medical record review of consecutive discharged patients who received noncontrast head CT scans in an urban ED for either minor closed head injury or atraumatic headache. Each patient's head CT radiologic report was reviewed for findings of sinusitis and classified as chronic sinusitis, indeterminate for sinusitis, air-fluid levels, or no findings of sinusitis.
  
  
  RESULTS
  We enrolled 500 patients (234 in the atraumatic headache group, 266 in the minor head injury group). The two groups were similar except that more women were enrolled in the atraumatic headache group. CT findings of chronic sinusitis in the atraumatic headache group (22.2%) and the minor head injury group (17.7%; difference 4.5%; 95% confidence interval of -2.5-11.6%).
  
  
  CONCLUSIONS
  Prevalence of CT findings of sinusitis in ED patients with atraumatic headaches and mild head injury are similar. This strongly suggests that CT findings of chronic sinusitis in patients with atraumatic headache may be incidental, and are rarely the cause of a patient's acute headache.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Kroll
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Camacho
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Shiva
authors.initials: S
authors.lastname: Gautam
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Robin B
authors.initials: RB
authors.lastname: Levenson
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Edlow
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging; D002908:Chronic Disease; D006259:Craniocerebral Trauma / Q000150:complications / Q000000981:diagnostic imaging*; D004636:Emergency Service, Hospital; D005260:Female; D006261:Headache / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012852:Sinusitis / Q000150:complications / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: CT scan; chronic sinusitis; diagnostic error; headache; sinusitis