The American Journal of Medicine
Volume 124, Issue 1 , Pages 58-63.e1 , January 2011

Patterns of Care and Outcomes After Computed Tomography Scans for Headache

  • John J. You, MD, MSc

      Affiliations

    • Departments of Medicine and of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
    • Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    • Corresponding Author InformationRequests for reprints should be addressed to John J. You, MD, MSc, 1200 Main Street West, HSC-3V51B, Hamilton Ontario, Canada, L8N 3Z5
    • ,
  • Jonathan Gladstone, MD

      Affiliations

    • Cleveland Clinic Canada, Toronto, Ontario, Canada
    • Department of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    • ,
  • Sean Symons, MD, MPH

      Affiliations

    • Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    • Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
    • ,
  • Dalia Rotstein, MD

      Affiliations

    • Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    • ,
  • Andreas Laupacis, MD, MSc

      Affiliations

    • Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    • Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    • Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    • Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
    • ,
  • Chaim M. Bell, MD, PhD

      Affiliations

    • Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    • Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    • Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    • Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada

References 

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  3. Pitts SR, Niska RW, Xu J, Burt CW. National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. Natl Health Stat Report. 2008;1–38
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  5. Vargas B. Migraine in modern media. Philadelphia, PA: Presented at: The International Headache Conference; September 12, 2009;
  6. Pryse-Phillips WE, Dodick DW, Edmeads JG, et al. Guidelines for the diagnosis and management of migraine in clinical practice (Canadian Headache Society). CMAJ. 1997;156:1273–1287
  7. Frishberg BM, Rosenberg JH, Matchar DB, et al. Evidence-based guidelines in the primary care setting: neuroimaging in patients with nonacute headache (American Academy of Neurology). http://www.aan.com/professionals/practice/pdfs/gl0088.pdf2010;Accessed April 27
  8. You JJ, Purdy I, Rothwell D, Przybysz R, Fang J, Laupacis A. Indications for and results of outpatient computed tomography and magnetic resonance imaging in Ontario: a population-based study. Can Assoc Radiol J. 2008;59:135–143
  9. Dumas MD, Pexman JH, Kreeft JH. Computed tomography evaluation of patients with chronic headache. CMAJ. 1994;151:1447–1452
  10. Weingarten S, Kleinman M, Elperin L, Larson EB. The effectiveness of cerebral imaging in the diagnosis of chronic headache. Arch Intern Med. 1992;152:2457–2462
  11. Akpek S, Arac M, Atilla S, Onal B, Yucel C, Isik S. Cost-effectiveness of computed tomography in the evaluation of patients with headache. Headache. 1995;35:228–230
  12. Sempere AP, Porta-Etessam J, Medrano V, et al. Neuroimaging in the evaluation of patients with non-acute headache. Cephalalgia. 2005;25:30–35
  13. Picard A. Scan use is up, but the value is questionable. Globe & Mail. April 16, 2009;L1
  14. Fazel R, Krumholz HM, Wang Y, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med. 2009;361:849–857
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  16. Juurlink D, Preyra C, Croxford R. Canadian Institute for Health Information Discharge Abstract Database: A Validation Study. Toronto: Institute for Clinical Evaluative Sciences; 2006;
  17. Robles SC, Marrett LD, Clarke EA, Risch HA. An application of capture-recapture methods to the estimation of completeness of cancer registration. J Clin Epidemiol. 1988;41:495–501
  18. Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–2284
  19. Smith-Bindman R, Lipson J, Marcus R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009;169:2078–2086
  20. Berrington de GA, Mahesh M, Kim KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. 2009;169:2071–2077
  21. Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM. Does this patient with headache have a migraine or need neuroimaging?. JAMA. 2006;296:1274–1283
  22. Howard L, Wessely S, Leese M, et al. Are investigations anxiolytic or anxiogenic? (A randomized controlled trial of neuroimaging to provide reassurance in chronic daily headache). J Neurol Neurosurg Psychiatry. 2005;76:1558–1564
  23. You JJ, Levinson W, Laupacis A. Attitudes of family physicians, specialists and radiologists about the use of computed tomography and magnetic resonance imaging in Ontario. Healthc Policy. 2009;5:54–65

 Funding: Dr You is supported by a Career Scientist Award from the Ontario Ministry of Health and Long-Term Care. Dr Bell is supported by a Canadian Institutes of Health Research and Canadian Patient Safety Institute Chair in Patient Safety and Continuity of Care. This study was conducted at the Institute for Clinical Evaluative Sciences, which is partially funded by the Ontario Ministry of Health and Long-Term Care.

 Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.

 Authorship: All authors had access to the data and played a role in writing this manuscript. All authors contributed to the concept and design of the study. Drs You, Gladstone, and Bell drafted the manuscript. All authors contributed to the analysis and interpretation of data, critically revised the manuscript for important intellectual content, and approved the final version.

PII: S0002-9343(10)00754-0

doi: 10.1016/j.amjmed.2010.08.010

The American Journal of Medicine
Volume 124, Issue 1 , Pages 58-63.e1 , January 2011

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