The degree and appropriateness of computed tomography utilization for diagnosis of headaches in Ghana
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Heliyon
Abstract
Introduction: Headache is a common and sometimes debilitating medical condition. Patients presenting with no
neurologic anomaly, nontraumatic primary headache require careful evaluation before neuroimaging. National
Guidelines standardizing exploitation of Computed Tomography (CT), the most utilized imaging modality in this
clinical scenario, has not been established in Ghana, a developing country with limited healthcare resources. The
country has not also adopted existing guidelines such as the National Institute for Health and Care Excellence
(NICE) of the United Kingdom or the Appropriateness Criteria (AC) of the American College of Radiologists
(ACR). The purpose of this review was to analyze the propensity of CT utilization for diagnosing headaches
against the AC of the ACR and discuss some of the socio-economic inferences thereof.
Methods: This study retrospectively reviewed CT imaging records and clinical data of all patients referred for head
CT scans between 1st January 2016 and 31st December 2018 at five major health facilities (four tertiary government
hospitals and one private hospital) across Ghana. We isolated all head CT scans performed for the
diagnosis of headache for analysis. We analyzed the type of presenting headache, CT findings, gender distribution,
pattern of referrals, and head CT appropriateness against the AC of the ACR.
Results: A total of 44,218 patients were referred to the five facilities for head CT secondary to diverse indications for
the period. All non-trauma cases were 41.7%; trauma cases were 31.6%, the majority (72.3%) were from road traffic
accidents. The majority (64.9%) of trauma casualties were males.Atotal of 11,806 (26.7%) patients were referred for
a head CT scan for the diagnosis of headache. The private hospital recorded the highest referrals for head CT scan for
diagnosis of headache. The gender distribution of all headache patients was 57.6% females, and 42.4% were males.
The age distribution showed 19.3% were children, 71.2% were adults, and the aged constituted 9.4%. The results
showed 2.8% significant cranial CT findings of all reviewed headache patients. Pathological findings among the
cohort of children were 0.6%.
The sources and pattern of referrals showed 57.3% were from the Outpatient Department, 26.6% from the Emergency
Department, in-patients’ referrals were 9.4%, and specialist consultation was 7.1%. Analysis of CT scans
performed against the AC of the ACR, showed 69.0% of headache patients were likely scanned inappropriately.
Conclusions: There is a need to implement international best practice guidelines or develop a national neuroimaging
policy to protect patients. Unjustified CT utilization for diagnosis of headaches exposes patients to unnecessary
ionizing radiation that can instigate cancer and unnecessary expenditure. Head CT scan for some
headache patients with normal neurologic findings may be unnecessary in an emerging country like Ghana.
Clinicians must, therefore, be discerning in CT scan requests for the diagnosis of headache.
Description
Research Article
Keywords
Headache, Neurologic anomaly, Computed tomography, Developing country, Appropriateness criteria, Neuroimaging guidelines, Ghana