Neuroimaging-use trends in nonacute pediatric headache before and after clinical practice parameters

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

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

OBJECTIVES. The objective of this study was to determine trends in diagnostic neuroim-aging-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.

Original languageEnglish (US)
JournalPediatrics
Volume122
Issue number5
DOIs
StatePublished - Nov 2008

Fingerprint

Neuroimaging
Headache
Pediatrics
Primary Health Care
Neurologic Examination
Neurology
Evidence-Based Medicine
Ambulatory Care
Practice Guidelines
Publications
Cross-Sectional Studies
Physicians

Keywords

  • Diagnostic procedures
  • Headache
  • Neuroimaging
  • Practice param eters/ guidelines
  • Practice-based research

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Neuroimaging-use trends in nonacute pediatric headache before and after clinical practice parameters. / Graf, William D.; Kayyali, Husam R.; Alexander, John J.; Simon, Steven D.; Morriss, Michael C.

In: Pediatrics, Vol. 122, No. 5, 11.2008.

Research output: Contribution to journalArticle

Graf, William D. ; Kayyali, Husam R. ; Alexander, John J. ; Simon, Steven D. ; Morriss, Michael C. / Neuroimaging-use trends in nonacute pediatric headache before and after clinical practice parameters. In: Pediatrics. 2008 ; Vol. 122, No. 5.
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abstract = "OBJECTIVES. The objective of this study was to determine trends in diagnostic neuroim-aging-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.",
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