WIP 14 - Reducing Non-Emergent Head Imaging for Atraumatic Headache in the Pediatric Emergency Department (PED), a Quality Improvement Study

Publication Number: WIP 14.7703

Gabrielle Pollack, Johns Hopkins Children's Center, Baltimore, MD, United States; Megan Rescigno, Johns Hopkins Children's Center, Baltimore, MD, United States; Ethan S. Vorel, Johns Hopkins Children's Center, Baltimore, MD, United States; Ann Kane, Johns Hopkins School Of Medicine, Baltimore, MD, United States

Background: Atraumatic headaches are a common complaint in patients presenting to pediatric emergency departments (PEDs). The decision to perform head imaging is made to rule out serious underlying conditions. The use of imaging can expose children to unnecessary radiation, increase costs, and lead to longer ED stays. However, there is variability in practices across institutions. There is a paucity of studies examining the frequency and indication of head imaging in PED settings for atraumatic headaches. This study aims to fill this gap by providing data and insights that can guide clinical practice.

Objective: To develop a clinical decision guideline (CDG) for patients presenting with atraumatic headaches and reduce non-emergent head imaging obtained in the PED by 15% within 18 months.

Design/Methods: The target population includes patients < 18 who presented with a chief complaint of atraumatic headache presenting to the PED. Patients with a history of head trauma, intracranial pathology or cranial surgery will be excluded.
Baseline data was obtained from 1/2023-6/2024. Patient charts were reviewed. The following metrics were included: gender, age, chief complaint, relevant exam findings, whether or not head imaging was obtained, neurology consultation, PED length of stay, and disposition. Baseline data revealed an MRI imaging rate of 36.4% for patients with atraumatic headache. This study is IRB approved.
Based on this initial data, we will construct a fishbone diagram to categorize contributing factors to neuroimaging ordering and work with a neurologist to review the current literature and develop a new CDG to reduce unnecessary head imaging.
Then, we will educate prescribers and review data related to head imaging orders on a monthly basis. Ongoing interventions will be through PDSA cycles and may include CDG added to the electronic medical record and radiology approval for neuroimaging orders.
Control charts will be used to compare the percentage of neuroimaging ordered pre and post interventions. As a balancing measure we will review 30-day bounce backs to the PED.