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Acta Paediatr. 2010 Jun;99(6):940-3. doi: 10.1111/j.1651-2227.2010.01728.x. Epub 2010 Feb 19.

When to image neurologically normal children with headaches: development of a decision rule.

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1
Paediatric Department, Queen's University Hospital, London, UK. mas.ahmed@bhrhospitals.nhs.uk

Abstract

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.

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