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Lots Of Docs Ignore Child CT Scan Guidelines

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At a clinic, an anxious parent brings in a child with a persistent headache. The child’s medical history contains no red flags, and a neurological examination comes up normal. Should the child get a CT brain scan?

No, say such professional organizations as the American College of Radiology (ACR) and the American Academy of Neurology (AAN). Yes, say a lot of doctors.

An article published online today in Pediatrics reports on a study of claims data for children ages 3 through 17 gleaned from 14 U.S. commercial health plans. It found, as the abstract puts it:

Use of CT scans to diagnose pediatric headache remains high despite existing guidelines, low diagnostic yield, and high potential risk.

Andrea DeVries, PhD, director of research operations for HealthCore, is the study’s lead author. HealthCore, based in Wilmington, Delaware, is a research organization owned by the health insurer WellPoint.

Guidelines issued by specialty practice organizations recommend against CT scans for children with headaches unless a child’s history or neurological exam point to something abnormal. The reason, obviously, is to limit the exposure of children to ionizing radiation.

Of course, exposure to demanding parents and crying children can also be a consideration—as can a doctor’s own experience or the particular circumstances of an individual case. “The widespread CT utilization across physician specialties may be due to misperceptions of the clinical benefits and risks of CT scan for diagnosis of headache,” the article says, “or to misinterpretation by the physicians of the expectations of children and their parents.”

Whatever the reason, the study found that 25 percent of the 15,836 children who presented at least two distinct medical claims for headache from January 1, 2007, through December 31, 2008, underwent at least one CT exam.

Nearly one third of those visited an emergency department. In fact, the study found, as many as 28 percent of pediatric CT scans ordered in the ED are related to headache. However, the study says, “Although ED visit was highly correlated with CT use, it is important to note that two thirds of the patients receiving CT scans had no ED visits at all during the study period.”

Family physicians were more likely to order CT; neurologists were much less likely to do so. The article suggests additional practice guidelines or educational programs might reduce the ordering of CT scans in such circumstances. Maybe. But don’t expect ingrained practice habits to change overnight.

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Related CME seminar (up to 29 AMA PRA Category 1 credits™): Pediatric Radiology—Clinical and Radiology Perspectives


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One Response to “Lots Of Docs Ignore Child CT Scan Guidelines”

  1. Radiology Daily»AlertArchive » Yet Another Study Finds CT Overuse In ED on July 17th, 2013 at 3:48 pm

    […] month, we reported on a study that found doctors use CT too often to diagnose headaches in children. In January 2012, we […]