ACR Appropriateness Criteria ® Headache–Child

Hayes, Laura L.; Palasis, Susan; Bartel, Twyla; Booth, Timothy N.; Iyer, Ramesh S.; Jones, Jeremy; Kadom, Nadja; Milla, Sarah Sarvis; Myseros, John S.; Pakalnis, Ann; Partap, Sonia; Robertson, Richard L.; Ryan, Maura E.; Saigal, Gaurav; Soares, Bruno P.; Tekes, Aylin; Karmazyn, Boaz

doi:10.1016/j.jacr.2018.03.017

Cited by 31 publications

(17 citation statements)

References 48 publications

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“…Finally, recommendations for carrying out a brain MRI on patients with headaches and seizures have also been established by the American College of Radiology Appropriateness Criteria. 34,35 In these guidelines, the high ratings of “appropriateness” given to high-risk headaches and focal seizures resemble our results.…”

Section: Discussionsupporting

confidence: 77%

The Clinical Utility of Inpatient Brain Magnetic Resonance Imaging in Children

et al. 2020

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The clinical applicability and yield of brain magnetic resonance imaging (MRI) in the setting of an inpatient pediatric department has not been investigated. The authors performed a retrospective chart review of nontraumatic/nonneurosurgical children who underwent brain MRI during their hospitalization in a general pediatric department over a 5-year period. Of the 331 children who underwent brain MRI, 148 (45%) had abnormal findings. High-risk headaches and focal seizures were significantly correlated with findings on brain MRI. Diagnostic and therapeutic yields were most significant in acute demyelinating events, acute cerebrovascular disorders, high-risk headaches when supported by neurologic and ophthalmologic findings, focal seizures with evidence of multifocal epileptic activity on an electroencephalogram and ophthalmic complaints when accompanied by cranial nerve palsy and optic nerve impairment. Since the contributions of a brain MRI in hospitalized children is pivotal in specific clinical situations, a judicious decision-making process should be done before its scheduling, in order to optimize clinical care.

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Section: Discussionsupporting

confidence: 77%

The Clinical Utility of Inpatient Brain Magnetic Resonance Imaging in Children

et al. 2020

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“…Non‐traumatic back pain in childhood is far more common than previously believed: its incidence increases with age, rising to around 25% during adolescence. While low back pain in childhood is typically benign and self‐limiting, according to American College of Radiology appropriateness criteria 2 the presence of constant, radicular, or night back pain lasting more than 4 weeks, abnormal neurologic examination—alone or in combination—represent clinical red flags that should prompt further blood tests and imaging evaluation. In particular, clinical findings of pain worsening at night and low‐grade temperature, as our patient complained, suggest an infectious or oncological etiology with the need of a timely and proper diagnostic workup.…”

Section: Discussionmentioning

confidence: 99%

Bartonella henselae vertebral osteomyelitis in a pediatric patient: A case report

Abu‐Rumeileh

Beltrami

Maurizio

et al. 2022

Clinical Case Reports

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“…The choice of the most correct sequences, CTA or if we use MRI (i.e., MRA, T2-weighted gradient-echo, diffusion-weighted sequences, and post-gadolinium-enhanced sequences), is fundamental to perform the most appropriate path to arrive at an etiological diagnosis by maximizing the capacity of the imaging technique with the minimum risk of the child [see ACR Appropriateness Criteria Headache Child for more detailed information ref. (81)]. In emergency setting some centers prefer the use of CTA over MRA so we would suggest considering both (one or the other) when vascular imaging is indicated.…”

Section: Evaluation Of Headache In Ed: How To Diagnose Headachementioning

confidence: 99%

Management of Childhood Headache in the Emergency Department. Review of the Literature

et al. 2019

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Headache is the third cause of visits to pediatric emergency departments (ED). According to a systematic review, headaches in children evaluated in the ED are primarily due to benign conditions that tend to be self-limiting or resolve with appropriate pharmacological treatment. The more frequent causes of non-traumatic headache in the ED include primitive headaches (21.8–66.3%) and benign secondary headaches (35.4–63.2%), whereas potentially life-threatening (LT) secondary headaches are less frequent (2–15.3%). Worrying conditions include brain tumors, central nervous system infections, dysfunction of ventriculo-peritoneal shunts, hydrocephalus, idiopathic intracranial hypertension, and intracranial hemorrhage. In the emergency setting, the main goal is to intercept potentially LT conditions that require immediate medical attention. The initial assessment begins with an in-depth, appropriate history followed by a complete, oriented physical and neurological examination. The literature describes the following red flags requiring further investigation (for example neuroimaging) for recognition of LT conditions: abnormal neurological examination; atypical presentation of headaches: subjective vertigo, intractable vomiting or headaches that wake the child from sleep; recent and progressive severe headache (<6 months); age of the child <6 years; no family history for migraine or primary headache; occipital headache; change of headache; new headache in an immunocompromised child; first or worst headache; symptoms and signs of systemic disease; headaches associated with changes in mental status or focal neurological disorders. In evaluating a child or adolescent who is being treated for headache, physicians should consider using appropriate diagnostic tests. Diagnostic tests are varied, and include routine laboratory analysis, cerebral spinal fluid examination, electroencephalography, and computerized tomography or magnetic resonance neuroimaging. The management of headache in the ED depends on the patient's general conditions and the presumable cause of the headache. There are few randomized, controlled trials on pharmacological treatment of headache in the pediatric population. Only ibuprofen and sumatriptan are significantly more effective than placebo in determining headache relief.

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ACR Appropriateness Criteria ® Headache–Child

Cited by 31 publications

References 48 publications

The Clinical Utility of Inpatient Brain Magnetic Resonance Imaging in Children

The Clinical Utility of Inpatient Brain Magnetic Resonance Imaging in Children

Bartonella henselae vertebral osteomyelitis in a pediatric patient: A case report

Management of Childhood Headache in the Emergency Department. Review of the Literature

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