Variability of physicians' thresholds for neuroimaging in children with recurrent headache

Carrie Daymont, Patrick J. McDonald, Kristy Wittmeier, Martin H. Reed, Michael Moffatt

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Background: We sought to determine the extent to which physicians agree about the appropriate decision threshold for recommending magnetic resonance imaging in a clinical practice guideline for children with recurrent headache.Methods: We surveyed attending physicians in Canada practicing in community pediatrics, child neurology, pediatric radiology, and pediatric neurosurgery. For children in each of six risk categories, physicians were asked to determine whether they would recommend for or against routine magnetic resonance imaging of the brain in a clinical practice guideline for children with recurrent headache.Results: Completed surveys were returned by 114 physicians. The proportion recommending routine neuroimaging for each risk group was 100% (50% risk), 99% (10% risk), 93% (4% risk), 54% (1% risk), 25% (0.4% risk), 4% (0.01% risk). Community pediatricians, physicians in practice >15 years, and physicians who believed they ordered neuroimaging less often than peers were less likely to recommend neuroimaging for the 1% risk group (all p < 0.05).Conclusions: There is no consensus among pediatric specialists regarding the appropriate decision threshold for neuroimaging in a clinical practice guideline for children with recurrent headache. Because of the impact that individual threshold preferences may have on guidelines, these findings support the need for careful composition of guideline committees and consideration of the role of patient and family preferences. Our findings also support the need for transparency in guidelines regarding how evidence was translated into recommendations and how conflicts were resolved.

Original languageEnglish (US)
Article number162
JournalBMC pediatrics
Volume14
Issue number1
DOIs
Publication statusPublished - Jun 23 2014

    Fingerprint

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this