Anna V Trofimova1, Divya Kishore2, Lindsey Urquia2, Grace Tewkesbury2, Richard Duszak1, Matthew D Levy3, Nadja Kadom4. 1. Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia. 2. Emory University School of Medicine, Atlanta, Georgia. 3. The Children's Care Network, Children's Healthcare of Atlanta, Atlanta, Georgia. 4. Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Radiology, Children's Healthcare of Atlanta- Egleston Campus, Atlanta, Georgia. Electronic address: nkadom@emory.edu.
Abstract
BACKGROUND: Despite a variety of evidence-based guidelines documents, imaging is anecdotally commonly used in the setting of children with headaches, but the frequency of such imaging is unknown. We assessed the use of and estimated costs of imaging utilization in children with headaches at a pediatric hospital. MATERIALS AND METHODS: Retrospectively reviewing charts of all relevant imaging examinations in 2015, we focused on radiology reports with indications containing the terms "headache" or "migraine" and excluded patients who fulfilled evidence-based criteria in support of obtaining imaging. All radiology results were recorded and categorized as normal, likely causative, possibly causative, or unlikely causative of headache. Societal costs were estimated using allowable Medicare fees, and losses of total facility time were estimated using scheduled examination slots. RESULTS: In 2015, 4,257 imaging studies were performed for indications of headache or migraine. Of these, 3,098 (73%) met our exclusion criteria, meaning they had appropriate indications, and 1,159 (27%) were presumably imaged outside of guideline recommendations. Overall, 19.8% (230 of 1,159) had diagnoses that were likely or potentially causative of headaches, and 71.2% (825 of 1,159) were normal. The remainder had findings unlikely to cause headaches. The total estimated societal cost of imaging studies for presumed primary headache imaging at our institution in 2015 was $322,422. The loss of imaging time was 845.3 hours. CONCLUSION: Given the large number of normal examinations and the inappropriate use of radiography, imaging utilization in children with headaches can likely be improved. In addition to reducing ionizing radiation and the need for sedation, reductions in unnecessary imaging would result in societal cost savings and increase imaging capacity for other patients.
BACKGROUND: Despite a variety of evidence-based guidelines documents, imaging is anecdotally commonly used in the setting of children with headaches, but the frequency of such imaging is unknown. We assessed the use of and estimated costs of imaging utilization in children with headaches at a pediatric hospital. MATERIALS AND METHODS: Retrospectively reviewing charts of all relevant imaging examinations in 2015, we focused on radiology reports with indications containing the terms "headache" or "migraine" and excluded patients who fulfilled evidence-based criteria in support of obtaining imaging. All radiology results were recorded and categorized as normal, likely causative, possibly causative, or unlikely causative of headache. Societal costs were estimated using allowable Medicare fees, and losses of total facility time were estimated using scheduled examination slots. RESULTS: In 2015, 4,257 imaging studies were performed for indications of headache or migraine. Of these, 3,098 (73%) met our exclusion criteria, meaning they had appropriate indications, and 1,159 (27%) were presumably imaged outside of guideline recommendations. Overall, 19.8% (230 of 1,159) had diagnoses that were likely or potentially causative of headaches, and 71.2% (825 of 1,159) were normal. The remainder had findings unlikely to cause headaches. The total estimated societal cost of imaging studies for presumed primary headache imaging at our institution in 2015 was $322,422. The loss of imaging time was 845.3 hours. CONCLUSION: Given the large number of normal examinations and the inappropriate use of radiography, imaging utilization in children with headaches can likely be improved. In addition to reducing ionizing radiation and the need for sedation, reductions in unnecessary imaging would result in societal cost savings and increase imaging capacity for other patients.