New tool can help hospitals choose wisely on brain CT in children with headache


By Natasha Doyle

1 Dec 2021

A tool adapted from the US could help Australian clinicians identify brain CT scan overuse and implement safer, higher-quality care in paediatric patients with atraumatic headache, a Victorian study suggests.

The study assessed whether a localised version of America’s “Overuse of CT scans for the evaluation of children with atraumatic headache” tool could accurately and feasibly detect patients receiving non-indicated scans in Australian healthcare settings.

It found the diagnostic code-dependent tool accurately identified atraumatic headache patients 95.3% of the time, with 601 relevant patients attending Melbourne’s Royal Children’s Hospital in 2017 and 2018. Of these, 98 received at least one CT scan, 14.1% of which were non-indicated.

This means that 2% of all atraumatic headache encounters received a non-indicated scan, Royal Children’s Hospital researcher Ms Yue Cherry Shi and her team wrote in Pediatric Emergency Care.

While valuable, the tool did have some feasibility issues, with clinicians needing to compare output with clinical notes, the authors wrote.

In some cases, diagnostic information was included in free-text rather than code fields, hindering patient detection. Additionally, some notes justified brain CT as “clinically indicated”, where codes might have suggested otherwise.

Regardless, there is a “need for high-quality measurement of [brain CT overuse] in more Australian health settings”, the authors wrote, noting that previous studies have seen non-indicated imaging used in up to 43% of patients despite its low diagnostic yield in neurologically normal children.

This results in potentially unnecessary health expenditure, patient inconvenience and harm exposure — putting patients at risk of severe acute reactions to intravenous contrast, sedation and/or anaesthesia and cancers linked to ionising radiation.

Brain CT for paediatric primary headache is one of The Australia and New Zealand Child Neurology Society’s “top 5 low-value practices and interventions” and considered “clinically non-indicated” for otherwise neurologically normal children in the American Academy of Neurology’s guidelines, the authors noted.

“This study provides a useful tool for the measurement of non-indicated brain CTs in children with atraumatic headache in Australia.”

“Using our approach, further research could obtain accurate measurement of the overuse of CT scans in more settings, and thus inform future interventions to minimise such overuse; minimise unnecessary harms; and provide safer, higher-quality care for children in Australia,” they concluded.

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