Prpić Igor, Ahel Tea, Rotim Krešimir, Gajski Domagoj, Vukelić Petar, Sasso Antun
Acta Clin Croat. 2014 Dec;53(4):449-54.
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.
在日常实践中，经常会对儿童头痛患者进行神经影像学检查以进行治疗管理。本研究的目的是确定在神经影像学检查的适应症方面，临床实践与临床实践指南之间是否存在显著差异。对里耶卡大学医院中心坎特里达儿科治疗的2至18岁慢性头痛儿童的病历进行了回顾性研究。对脑磁共振成像和计算机断层扫描（MRI/CT）的检查适应症进行了审查，并与临床实践指南进行了比较。215名儿童中有164名（76.3%）进行了脑成像检查，其中93名（56.7%）进行了MRI检查，71名（43.3%）进行了CT检查。脑MRI/CT检查的适应症如下：儿童家庭的焦虑和/或坚持（71.3%）、存在提示神经功能障碍的相关特征（13.4%）、5岁以下（12.8%）以及神经系统检查异常（2.4%）。大多数儿童（71.4%）的神经影像学检查结果正常。在其余的影像学检查中（28.1%），MRI/CT显示出不同的脑内/脑外检查结果，但这些结果并未影响头痛治疗的改变。只有一名（0.60%）患者在MRI/CT检查后需要改变头痛治疗方案。研究结果证明，尽管有循证临床指南，但慢性头痛儿童的脑成像检查仍被过度使用，主要是为了减轻家庭/患者的焦虑。
