Graf William D, Kayyali Husam R, Alexander John J, Simon Steven D, Morriss Michael C
Sections of aNeurology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri 64108, USA.
Pediatrics. 2008 Nov;122(5):e1001-5. doi: 10.1542/peds.2008-1159. Epub 2008 Oct 6.
The objective of this study was to determine trends in diagnostic neuroimaging-use rates in nonacute pediatric headache before and after publication of clinical practice guidelines.
Retrospective, cross-sectional analysis was conducted of neuroimaging rates for 725 children and adolescents who were aged 3 to 18 years with nonacute headache and normal neurologic examination and were evaluated in a single pediatric neurology clinic during study years 1992, 1996, 2000, and 2004. Following recommendations of current practice parameters, patients with conditions that justify consideration for neuroimaging (eg, progressive headache, abnormal neurologic examination) were excluded from this analysis. We recorded the origin of any neuroimaging request at the time of the clinic visit and any abnormal neuroimaging findings that led to major clinical consequences.
Overall, the mean rate of neuroimaging for patients with nonacute headache was 45%. Use rates remained steady during the 13-year study period (range: 41%-47%). The majority of neuroimaging studies were ordered originally by primary care providers. The proportion of neuroimaging studies that were ordered by primary care providers increased significantly from 1992 to 2004.
In the evaluation of patients who had nonacute pediatric headache and were referred to a child neurology clinic, neuroimaging-use rates remained stable during the past decade. An increasing proportion of neuroimaging studies are ordered by primary care providers. The influence of evidence-based medicine on medical decision-making may be partly responsible for curbing increases in neuroimaging overuse. The perceived value of neuroimaging by physicians and consumers deserves ongoing study.
本研究的目的是确定临床实践指南发布前后非急性小儿头痛诊断性神经影像学使用率的趋势。
对1992年、1996年、2000年和2004年研究期间在一家儿科神经科诊所接受评估的725名3至18岁非急性头痛且神经系统检查正常的儿童和青少年的神经影像学检查率进行回顾性横断面分析。根据当前实践参数的建议，将有理由考虑进行神经影像学检查的疾病患者（如进行性头痛、神经系统检查异常）排除在本分析之外。我们记录了门诊就诊时任何神经影像学检查申请的来源以及导致重大临床后果的任何异常神经影像学检查结果。
总体而言，非急性头痛患者的神经影像学检查平均使用率为45%。在13年的研究期间，使用率保持稳定（范围：41%-47%）。大多数神经影像学检查最初是由初级保健提供者开具的。从1992年到2004年，初级保健提供者开具的神经影像学检查比例显著增加。
在对转诊至儿童神经科诊所的非急性小儿头痛患者的评估中，过去十年神经影像学检查使用率保持稳定。初级保健提供者开具的神经影像学检查比例不断增加。循证医学对医疗决策的影响可能是抑制神经影像学检查过度使用增加的部分原因。医生和消费者对神经影像学检查的认知价值值得持续研究。
