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

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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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Keywords: Brain imaging; Children; Decision rule; Headache; Red flags

Document Type: Research Article

Affiliations: 1: .Paediatric Department, Queen’s University Hospital, London, UK 2: .Paediatric Neurology, The Royal London Hospitals, London, UK 3: .Department of Neuroradiology, Great Ormond Street Hospital, London, UK 4: .School of Human Development, University of Nottingham, Nottingham, UK

Publication date: 2010-06-01

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