caa a22 4500 606171940 CHVBK 20210128100725.0 cr unu---uuuuu 210128e20151001xx s 000 0 eng 10.1007/s10140-015-1314-9 doi (NATIONALLICENCE)springer-10.1007/s10140-015-1314-9 Computed tomography for non-traumatic headache in the emergency department and the impact of follow-up testing on altering the initial diagnosis [Elektronische Daten] [Jeffrey Quon, Rafael Glikstein, Christopher Lim, Betty Schwarz] The purpose of this study was twofold: (1) to determine the incidence of positive computed tomography (CT) findings in patients presenting to the emergency department (ED) with non-traumatic headache at our institution and (2) to examine follow-up exams, including lumbar puncture, non-enhanced CT, CT angiogram, CT venogram, and magnetic resonance imaging (MRI), to see how often the use of further testing changes the diagnosis. With IRB approval, 865 patients were identified through ED requisitions for CT head with the indication of headache during the calendar year 2011. Exclusion criteria included head trauma, prior intracranial surgery, focal neurologic symptoms, and known intracranial mass. CT results were divided into three categories: P0, P1, and P2. Negative studies were graded as P0. Positive studies were subdivided into clinically insignificant or P1 and clinically significant or P2. Clinically significant was defined as requiring medical treatment. Subsequently, the electronic medical records and picture archiving and communication system (PACS) were reviewed to determine the incidence of follow-up exams, including lumbar puncture or imaging. The secondary tests were divided into the same P0, P1, and P2 categories. There were 254 positive studies: P1 clinically insignificant (27.1%, 235/865) and P2 clinically significant (2.2%, 19/865). Of 257 follow-up exams performed, the majority were lumbar punctures (36.0%) or CT angiograms (29.5%). In 19/257 exams or 7.4%, the additional testing changed the clinically insignificant (P0/P1) diagnosis to a significant (P2) result. At our institution, there was a 2.2% incidence of significant positive CT findings in patients presenting to the ED with non-traumatic headache. Follow-up testing was variable and resulted in a 7.4% increase in the severity of diagnosis compared to the initial negative CT scan. American Society of Emergency Radiology, 2015 Non-traumatic headache nationallicence CT head nationallicence Emergency department nationallicence Headache screening nationallicence Quon Jeffrey Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, K1Y 4E9, Ottawa, Ontario, Canada aut Glikstein Rafael Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, K1Y 4E9, Ottawa, Ontario, Canada aut Lim Christopher Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, K1Y 4E9, Ottawa, Ontario, Canada aut Schwarz Betty Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, K1Y 4E9, Ottawa, Ontario, Canada aut Emergency Radiology Springer Berlin Heidelberg 22/5(2015-10-01), 521-525 1070-3004 22:5<521 2015 22 10140 https://doi.org/10.1007/s10140-015-1314-9 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10140-015-1314-9 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Quon Jeffrey Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, K1Y 4E9, Ottawa, Ontario, Canada aut NATIONALLICENCE 700 1- Glikstein Rafael Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, K1Y 4E9, Ottawa, Ontario, Canada aut NATIONALLICENCE 700 1- Lim Christopher Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, K1Y 4E9, Ottawa, Ontario, Canada aut NATIONALLICENCE 700 1- Schwarz Betty Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, K1Y 4E9, Ottawa, Ontario, Canada aut NATIONALLICENCE 773 0- Emergency Radiology Springer Berlin Heidelberg 22/5(2015-10-01), 521-525 1070-3004 22:5<521 2015 22 10140