title: The use of neuroimaging in the management of chronic headache in children in clinical practice versus clinical practice guidelines.
abstract: In daily practice, neuroimaging studies are frequently performed for the management of childhood headache. The aim of this study was to determine whether there is significant discrepancy between clinical practice and clinical practice guidelines on the indications for neuroimaging studies. Medical records of children with chronic headache, aged 2 to 18 years and treated at Rijeka University Hospital Center, Kantrida Department of Pediatrics, were retrospectively reviewed. Indications for brain magnetic resonance imaging and computed tomography (MRI/CT) scanning were reviewed and compared with clinical practice guidelines. Brain imaging was performed in 164 (76.3%) of 215 children, MRI in 93 (56.7%) and CT in 71 (43.3%) children. Indications for brain MRI/CT were as follows: anxiety and/or insistence by the child's family (71.3%), presence of associated features suggesting neurologic dysfunction (13.4%), age under 5 years (12.8%) and abnormal neurologic examination (2.4%). The majority of children (71.4%) had normal neuroimaging findings. In the rest of imaging studies (28.1%), MRI/CT revealed different intracerebral/extracerebral findings not influencing changes in headache management. Only one (0.60%) patient required change in headache management after MRI/CT. Study results proved that, despite available evidence-based clinical guidelines, brain imaging in children with chronic headaches is overused, mostly in order to decrease anxiety of the family/patient.
authors: Igor
authors: I
authors: Prpić
authors: Tea
authors: T
authors: Ahel
authors: Krešimir
authors: K
authors: Rotim
authors: Domagoj
authors: D
authors: Gajski
authors: Petar
authors: P
authors: Vukelić
authors: Antun
authors: A
authors: Sasso
mesh_terms: D001927:Brain Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002648:Child; D002669:Child Welfare / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D020773:Headache Disorders / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D059906:Neuroimaging / Q000379:methods / Q000592:standards*; D009460:Neurologic Examination; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D014057:Tomography, X-Ray Computed / Q000379:methods; D019564:Unnecessary Procedures