HealthCore: 20 Years of Real-World Evidence


CT Scans in Pediatric Patients with Headache

While headaches are very common in children and adolescents, many parents fear the worst. “What if it’s a brain tumor?”  They find relief in the computed tomography (CT) scan as the best way to rule out the presence of a brain tumor.  But what they don’t know is that these diagnostic tests are actually increasing their children’s lifetime risk of cancer.

For this reason, many treatment guidelines and recommendations caution against CT scans for diagnosing headache.  In addition to their detrimental health effects, CT scans are not cheap, costing anywhere between $410 and $2,334 according to a recent article by Health.com.

So why are CT scans in pediatric patients with headache so rampant?

HealthCore recently conducted a study that looked across all treatment settings to identify factors associated with increased likelihood of neuroimaging.  In general, we found two main explanations for widespread CT use in the diagnosis of headache.

1. Many parents are unaware of the dangers

Pediatricians surveyed said they focused on diagnostic testing rather than treatment in order to ease mothers’ concerns about the presence of a brain tumor (Raieli).  In reality, less than 1% of brain abnormalities in children present with headache as the only symptom (Dooley).

2. Many physicians underestimate the dangers

Physicians ordering CT scans may underestimate the radiation risk or may mistakenly believe the risk is limited to infants (Broder). Only 9% of ED physicians in a survey perceived an increased risk of cancer associated with CT scans, compared with 47% of radiologists surveyed (Lee).

This study suggests a major opportunity to reduce the overuse of these tests.

Physicians and patients should seek to better understand the health benefits, risks, costs and appropriate use of imaging tests using educational resources like this report on Imaging Tests for Headaches published by Choosing Wisely, an initiative of the ABIM Foundation in partnership with Consumer Reports that seeks to advance a national dialogue on avoiding wasteful or unnecessary medical tests, treatments and procedures.

Previous studies have covered the use of emergency department CT scan use, however, our study is unique in that it is the first to compare children across treatment settings and provider specialties.

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