When to image neurologically normal children with headaches: development of a decision rule
Version of Record online: 19 FEB 2010
© 2010 The Author(s)/Journal Compilation © 2010 Foundation Acta Pædiatrica
Volume 99, Issue 6, pages 940–943, June 2010
How to Cite
Ahmed, M., Martinez, A., Cahill, D., Chong, K. and Whitehouse, W. (2010), When to image neurologically normal children with headaches: development of a decision rule. Acta Paediatrica, 99: 940–943. doi: 10.1111/j.1651-2227.2010.01728.x
- Issue online: 4 MAY 2010
- Version of Record online: 19 FEB 2010
- Received 12 October 2009; revised 16 December 2009; accepted 21 January 2010.
- Brain imaging;
- Decision rule;
- Red flags
Aims: The aim of this study was to develop and refine a decision rule on when to undertake brain imaging (BI) in neurologically normal children with headaches.
Methods: From the literature and a questionnaire study, a list of red flags (RFs) was drawn-up. During the prospective 4-year period, consecutive children with headache were classified according to RFs and the headache diagnosis.
Result: Three of 709 (0.4%) neurologically normal children had significant brain abnormalities. BI was carried out in 389 of 498 (78%) children with RFs. Significant abnormalities were found in three of 389 children (0.8%), all had unclassified headache (UH). BI was not arranged for the 211 children with no RFs. None of these developed RFs or abnormal signs on follow-up for a mean of 13 months.
Conclusion: In addition to BI for those with neurological signs, we think BI should be considered for neurologically normal patients with UH and RFs. This would have saved imaging children needlessly: only 101 of 709 (14%) would have had scans arranged, instead of 389 of 709.