Published online October 6, 2008
PEDIATRICS (doi:10.1542/peds.2008-1159)
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ARTICLE

Neuroimaging-Use Trends in Nonacute Pediatric Headache Before and After Clinical Practice Parameters

William D. Graf, MDa, Husam R. Kayyali, MDa, John J. Alexander, MDa, Steven D. Simon, PhDb and Michael C. Morriss, MDc

a Sections of Neurology
b Medical Research
c Department of Radiology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri

OBJECTIVES. 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.

METHODS. 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.

RESULTS. 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.

CONCLUSIONS. 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.

Key Words: Diagnostic procedures • headache • neuroimaging • practice parameters/guidelines • practice-based research

Abbreviations: CT—computed tomography

Accepted Jul 21, 2008.