Imaging Use & Atraumatic Headache in the ED

Atraumatic headache is one of the most common complaints in EDs, but only a small subset of patients who present to the ED with this complaint are found to have life-threatening intracranial pathology (ICP) upon imaging. Additionally, imaging guidelines for these patients remain unclear. As a result, emergency physicians face a serious diagnostic dilemma when managing atraumatic headache, says John W. Gilbert, MD. “Imaging infrequently reveals significant findings, but results from these tests nevertheless have the potential to detect life-threatening pathology.” [polldaddy poll=6862787] Several studies have demonstrated that overall use of diagnostic imaging in the ED is increasing. The causes are thought to be multifactorial, ranging from medicolegal concerns and patient demand to the availability of diagnostic scanners that operate at ever-faster rates. This has the potential to lead to imaging overutilization with little benefit and may potentially harm patients. In clinical studies, increased use of imaging has been associated with higher costs, longer patient wait times, greater exposure to ionizing radiation, and decreased ED flow and efficiency. “In the absence of clear evidence-based guidelines and given the potential consequences of misdiagnosis, many physicians understandably struggle when deciding whether to pursue further workup,” explains Dr. Gilbert. “In some cases, they may err on the side of increased testing. It’s important for physicians to be aware of recent trends in imaging utilization, particularly when there’s a sharp increase without obvious corresponding evidence of benefit. This information can help guide efforts toward better defining imaging criteria so that diagnostics are used appropriately.” Imaging & Diagnostics in Atraumatic Headache In the July 2012 Emergency Medicine Journal, Dr. Gilbert and colleagues had a...