Mahbubul Patwary MD, Presenter: Nothing to Disclose

Daniel Fung MD, Abstract Co-Author: Nothing to Disclose

Michael T. Mantello MD, Abstract Co-Author: Nothing to Disclose

Each year as many as 3 million patients present to an emergency department (ED) for treatment of headache. With the rising use of imaging, neuroimaging has become an important financial and radiation safety issue. We investigated the diagnostic utility of computed tomography (CT) scans of the brain in patients with headache in order to propose a revised indication for neuroimaging in the community hospital emergency room setting.  

Electronic medical records from August 2013 to April 2014 were reviewed retrospectively from any patient who presented to the ED with a non-traumatic headache, as a primary or secondary diagnosis, who had a CT scan of the brain. Clinical stratification of headaches was not performed in order to exclude potential subjective data. Quantifiable measures including vital signs, lab values and physical exams were reviewed in order to identify potential risk factors. Outcome of this study was defined as any positive finding on neuroimaging requiring hospital admission.

179 patients met the inclusion criteria and only two patients (1.1%) had neuroimaging findings requiring admission. The positive cases presented with focal neurological symptoms, hypertension greater than 140/90 mmHg, and age > 60. Non-contributory variables included sex, general appearance, other vital signs, and acute phase laboratory values. Furthermore, 27 patients with a known history of migraines (15.1%) did not demonstrate any positive neuroimaging findings. 

The overwhelming majority of patients who presented to the emergency department with a headache had a neuroimaging study not requiring admission. The data suggests most of these scans are unnecessary and lead to increased radiation exposure and healthcare costs. This preliminary data is part of a longitudinal study, which can potentially set guidelines for appropriate neuroimaging in the ED.  

The benfit of neuroimaging in the setting of headache may be not be justified by the radiation risk and associated healthcare cost  

Patwary, M, Fung, D, Mantello, M, Role of Neuroimaging in Patients Presenting with Headache in the Emergency Room.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008162.html