Audit of Appropriateness and Outcome of Computed Tomography Brain Scanning for Headaches in Paediatric Patients

EYL Kan, IYC Wong, SPC Lau

Hong Kong J Radiol 2005;8:202-6

Objective: To assess the appropriateness and outcomes of computed tomography brain scanning for headaches in a paediatric population.

Materials and Methods: Medical records and radiological reports for all computed tomography brain scans performed on paediatric patients aged 18 years or younger presenting with headache during the period 1 July 2005 to 31 December 2005 at Tuen Mun Hospital were reviewed. All headache variants were allocated an appropriateness rating for imaging based on the American College of Radiology Appropriateness Criteria values for children with headache. The case distribution of different appropriateness rating values was then analysed to produce an overall picture of the appropriateness of the computed tomography studies performed.

Results: The yield of positive findings was highest in those with fever or underlying disease (59%), and substantial also (25%) for those with a history of trauma. These were the only patient groups who were found to have significant intracranial pathology on computed tomography brain examinations.

Conclusions: This audit suggests that a proportion of the computed tomography studies performed for children presenting with headache may have been inappropriate. The development of a local guideline for imaging referral is indicated.