Gandhi Rohit, Lewis Evan Cole, Evans Jeanette W, Sell Erick
1Department of Pediatric Neurology,Children's Hospital of Eastern Ontario.
CJEM. 2015 Mar;17(2):148-53. doi: 10.2310/8000.2014.141409.
Headaches are a common problem in the pediatric population. In 2002, the American Academy of Neurology (AAN) developed guidelines on neuroimaging for patients presenting with headache. Our objective was to determine the frequency of computed tomographic (CT) scanning ordered by a range of medical practitioners for pediatric patients presenting with primary headache.
A retrospective chart review was conducted at the Children's Hospital of Eastern Ontario (CHEO), a tertiary care centre in Ontario. One hundred fifty-one records of patients referred to the outpatient neurology clinic at CHEO with ''headache'' or ''migraine'' as the primary complaint from 2004 to 2009 were randomly selected. Ninety-nine patients with normal neurologic examinations were ultimately included.
Thirty-four patients (34%; 95% CI 25-45) had undergone CT scanning. None of the 34 CT scans (0%; 95% CI 0-10) showed significant findings, and none changed the headache diagnosis or management. Eleven (32%) of the CT scans were ordered by CHEO neurologists, 15 (44%) by community physicians, and 8 (24%) by CHEO emergency physicians.
A high proportion of children presenting with primary headaches and a normal neurologic examination undergo CT scanning, despite well-established AAN guidelines regarding neuroimaging. Most of these CT scans do not appear to alter diagnosis and management. A variety of non-evidencebased factors may be encouraging physicians to overinvestigate this population and, as a result, increasing the risk of adverse events due to radiation exposure. Implementing initiatives at a site-based level that promote the use of established guidelines before performing CT scanning in this population may be beneficial.
头痛是儿科人群中的常见问题。2002年，美国神经病学学会（AAN）制定了针对头痛患者的神经影像学检查指南。我们的目的是确定一系列医学从业者为患有原发性头痛的儿科患者开具计算机断层扫描（CT）的频率。
在安大略省的三级医疗中心东安大略儿童医院（CHEO）进行了一项回顾性病历审查。随机选择了2004年至2009年期间因“头痛”或“偏头痛”为主诉转诊至CHEO门诊神经科的151例患者记录。最终纳入了99例神经系统检查正常的患者。
34例患者（34%；95%置信区间25 - 45）接受了CT扫描。34次CT扫描均未显示显著结果（0%；95%置信区间0 - 10），也没有改变头痛的诊断或治疗方案。其中11次（32%）CT扫描由CHEO神经科医生开具，15次（44%）由社区医生开具，8次（24%）由CHEO急诊科医生开具。
尽管AAN有关于神经影像学检查的既定指南，但许多患有原发性头痛且神经系统检查正常的儿童仍接受了CT扫描。这些CT扫描大多似乎并未改变诊断和治疗方案。多种非循证因素可能促使医生对这一人群进行过度检查，从而增加了因辐射暴露导致不良事件的风险。在该人群中进行CT扫描前，在机构层面推行促进使用既定指南的举措可能会有所帮助。
