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Neuroimaging Use in Youth with Headache Examined

J Pediatr; ePub 2018 Jun 14; Cain, Arkilo, et al

In a recent study that evaluated emergency department (ED) use and outcomes for headache in a free-standing children’s hospital system, researchers discovered that imaging rate was 26.5 times higher than the positive result rate, suggesting there is room to decrease unnecessary neuroimaging. They prospectively enrolled children aged 6-18 years who presented to the ED with a chief complaint of headache from September 2015 to September 2016. Standardized data collection was performed in real time, including telephone follow-up as needed, and imaging outcome was determined through a chart review. They found:

  • Of 294 enrolled patients, 53 (18%) underwent neuroimaging (computed tomography or magnetic resonance imaging) and 2 (0.7%) had clinically important intracranial findings.
  • Presenting with abnormal neurologic examination findings (odds ratio [OR], 11.55), no history of similar headaches (OR, 2.13), and white race (OR, 3.04) were significantly associated with an increased odds of undergoing imaging in multivariable regression models.

The increased odds of imaging white patients suggests bias that should be addressed. In addition, the low rate of positive findings supports the need for an evidence-based clinical decision tool for neuroimaging in the acute care setting.


Cain MR, Arkilo D, Linabery AM, Kharbanda AB. Emergency department use of neuroimaging in children and adolescents presenting with headache. [Published online ahead of print June 14, 2018]. J Pediatr. doi:10.1016/j.jpeds.2018.05.023.