UTILIZATION OF DIAGNOSTIC IMAGING IN THE EVALUATION OF HEADACHE: CONFORMANCE WITH CLINICAL PRACTICE PARAMETERS AND EFFECTS OF ADVANCED ACCESS SCHEDULING

Objectives: To assess the utilization of diagnostic imaging in the evaluation of recurrent headache in a referral child neurology clinic setting; to determine whether such utilization conforms to the clinical practice parameter (CPP); and, to determine whether advanced access scheduling (AAS) to the child neurology clinic influences rates of test utilization.

Methods: A retrospective chart audit of consecutive evaluations of recurrent headache in a child neurology clinic during five study periods over a 13-year period. Patients with progressive headache or abnormalities on neurological examination were excluded. Criteria for diagnostic neuroimaging were judged as appropriate or inappropriate based on recommendations of the CPP. Imaging utilization rates from the traditional clinic scheduling (TCS) were compared to those after the implementation of AAS.

Results: During TCS study years 1992, 1996, 2000, and 2004, a total of 725 patient charts were studied. A preliminary audit of 25 charts was possible in the initial AAS study year, 2005. Available 2004 scheduling data from the TCS period showed a mean waiting time of 55 days (range 28–103 days). The mean waiting time after AAS was 4 days (range 1–10 days). Inappropriate neuroimaging rates from 1992–2004 ranged between 41–47%. After implementation of AAS, inappropriate neuroimaging was 48%. In all study years, most neuroimaging was ordered by primary care providers (range 60–90%) and no statistically significant trends were noted. No unexpected pathological neuroimaging findings were present in the scans performed. Conclusion: The preliminary findings in this study suggest that AAS to the specialty of child neurology does not lead a reduction of inappropriate neuroimaging in children with recurrent, non-progressive headache. The findings in this study support the recommendations of the CPP in the evaluation of pediatric headache and suggest that over-utilization of neuroimaging will only decrease after actions such as educational campaigns or changes in re-imbursement.