CT Scans in Children with Headaches Used Widely in and out of ER, According
to Pediatrics Study
Sixty-seven percent received their scans outside of the emergency department
INDIANAPOLIS -- July 9, 2013
More than one quarter of the children treated for headache across a range of
care settings received a computed tomography scan, possibly exposing them to
unnecessary radiation and increased cancer risks, according to an article in
the July edition of Pediatrics.
“It’s ironic that providers sometimes use CT scans to rule out brain tumors or
brain abnormalities because parents are concerned about this possibility —
which is the cause of less than 1 percent of those with pediatric headache –
when overuse of CT scans can increase the risk of brain tumors,” said
co-author Dr. Paul Young, professor of pediatrics at the University of Utah
School of Medicine, who was one of the individuals designated by the American
Academy of Pediatrics to participate in the research. “It’s possible that
physicians underestimate the risks associated with CT scans.”
The use of CT scans to diagnose pediatric headache remains high despite
increased cancer risks and the fact that except for certain narrow
indications, providers often gain little clinically useful information from
these imaging studies while exposing children to unnecessary radiation.
Headaches are among the five most common health issues in children, as well as
one of the most frequent reasons for pediatric neuroimaging, particularly in
The Pediatrics study found that children who were evaluated in the emergency
room were four times more likely to have CT scans than those children who did
not go to the emergency room. However, even outside the emergency room, use of
CT scans remained widespread. In pediatric patients getting CT scans for
headaches, 67 percent received their scans outside of the emergency department
Other studies have drawn correlations that CT scans increase a child’s
lifetime risk of cancer. A retrospective study published in the Lancet in 2012
suggested that the cumulative radiation from as few as two to three CT scans
in a child younger than 15 years old could triple the risk of brain tumors,
while five to 10 head scans could triple the risk of leukemia. A study just
published in the June edition of JAMA Pediatrics noted that a
radiation-induced solid cancer is projected to result from every 300 to 390
abdomen/pelvis scans in girls.
The Pediatrics study, written by authors either employed by or designated by
HealthCore, American Academy of Pediatrics, American Academy of Family
Physicians, American Academy of Neurology and WellPoint, stemmed from
discussions by WellPoint and AAP to find out “to what extent do current
practice patterns for treatment of pediatric headache align with practice
guidelines?” An advisory group including representatives from the AAP, AAN,
and AAFP helped frame the discussion that resulted in this study.
The American Academy of Neurology recommends in favor of MRIs as opposed to CT
imaging for people with headache, a normal history and neurologic examination.
This recommendation was endorsed by the American Academy of Pediatrics and the
American Colleges of Radiology.
“We found that AAN imaging guidelines were most often followed by neurologists
when treating children, but not by other physicians,” said Dr. Alan Rosenberg,
WellPoint vice president of medical and clinical pharmacy policy. “We want to
better understand current utilization patterns to help parents of patients,
clinicians, and health benefits companies with the information we need to
inform and facilitate change to improve care for children and adolescents.”
In 2008, 1.7 million pediatric CT scans were performed in the emergency room,
nearly six percent of all pediatric emergency room visits that year.
As many as 28 percent of those scans were performed for headache unrelated to
head injury. Quality improvement initiatives, such as those supported by AAN
and advocated in the Choosing Wisely Campaign by the AAP, could significantly
reduce pediatric and adolescent exposure to unnecessary radiation.
The retrospective analysis included 15,836 children aged three to 12 years old
with more than two medical claims for headache.
The article was authored by Andrea DeVries of HealthCore, Dr. Paul Young of
University of Utah School of Medicine, Thomas Getchius of the American Academy
of Neurology, Chia-hsuan Li of HealthCore and Dr. John Whitney and Dr. Alan
Rosenberg of WellPoint.
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About HealthCore, Inc.
HealthCore, based in Wilmington, Del., is the clinical outcomes research
subsidiary of WellPoint, Inc. HealthCore has a team of highly experienced
researchers including physicians, biostatisticians, pharmacists,
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Lori McLaughlin, 317.407.7403
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