Neuroimaging of patients with headache in the pediatric emergency department: A single center retrospective study

Abstract

Background: Headache is a common neurologic complaint in children and adolescents, and the secondary causes of headache in these patients should be identified and excluded. We investigated the sensitivity and specificity of red flags in children with headache admitted to the emergency room and the associations of red flags with abnormal findings in neuroimaging, especially in serious pathologies.

Methods: A retrospective review was conducted on individuals under <18 years old with headache who visited the emergency department at Pusan National University Hospital, the Republic of Korea, from January 2017 to December 2022. In total, 267 patients were included in this study.

Results: Using the positive likelihood ratio, the association between each red flag with the positive results of neuroimaging was calculated. Red flags such as fever (P < 0.001), past history of neoplasm (P = 0.002), gradual worsening (P < 0.001), painful eye (P = 0.02), posttraumatic onset (P = 0.037), precipitated by exercise or Valsalva maneuver (P = 0.021) and lack of response to painkiller (P = 0.004) were statistically significant in patients with the positive neuroimaging results. Of 267 patients, 16 patients (6.0 %) had life-threatening headache that required urgent treatment and similar red flags were statistically significant in this group.

Conclusions: Red flags are useful reminders for physicians regarding whether to perform neuroimaging in the emergency department for patients with headache. Clinicians should perform neuroimaging depending on each circumstance and consider the red flags.

Keywords: Emergency room; Headache; Neuroimaging; Pediatrics.