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 setting
INDIANAPOLIS--(BUSINESS WIRE)-- 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 emergency departments.
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 setting.
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.
At WellPoint (NYS: WLP) , we believe there is an important connection between our members' health and well-being—and the value we bring our customers and shareholders. So each day we work to improve the health of our members and their communities. And, we can make a real difference since we have nearly 36 million people in our affiliated health plans, and nearly 68 million people served through our subsidiaries. As an independent licensee of the Blue Cross and Blue Shield Association, WellPoint serves members as the Blue Cross licensee for California; and as the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. In a majority of these service areas, WellPoint's plans do business as Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia and Empire Blue Cross Blue Shield, or Empire Blue Cross (in the New York service areas). We also serve customers in several additional states through our Amerigroup subsidiary and in certain markets through our CareMore subsidiary. Our 1-800 CONTACTS, Inc. subsidiary offers customers online sales of contact lenses, eyeglasses and other ocular products. Additional information about WellPoint is available at www.wellpoint.com.
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, epidemiologists, health economists and other scientists who study the "real world" safety and effectiveness of drugs, medical devices and care management interventions. HealthCore offers insight on how to best use this data and communicates these findings to health care decision-makers to support evidence-based medicine, product development decisions, safety monitoring, coverage decisions, process improvement and overall cost-effective health care. For more information, go to www.healthcore.com.
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