The degree and appropriateness of computed tomography utilization for diagnosis of headaches in Ghana.

Autor:	Gorleku PN; Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.; P.M.B University of Cape Coast, Cape Coast, Ghana., Dzefi-Tettey K; Department of Radiology, Korle Bu Teaching Hospital, Accra, Ghana., Edzie EKM; Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.; P.M.B University of Cape Coast, Cape Coast, Ghana., Setorglo J; Department of Medical Biochemistry, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.; P.M.B University of Cape Coast, Cape Coast, Ghana., Piersson AD; Department of Imaging Technology & Sonography, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.; P.M.B University of Cape Coast, Cape Coast, Ghana., Ofori IN; Department of Imaging Technology & Sonography, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.; P.M.B University of Cape Coast, Cape Coast, Ghana., Brobbey IF; Department of Radiology, Sunyani Regional Hospital, Sunyani, Ghana., Fiagbedzi EW; Department of Radiology, Komfo Anokye Teaching Hospital, Kumasi, Ghana., Brakohiapa EKK; Department of Radiology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana.
Jazyk:	angličtina
Zdroj:	Heliyon [Heliyon] 2021 Apr 07; Vol. 7 (4), pp. e06722. Date of Electronic Publication: 2021 Apr 07 (Print Publication: 2021).
DOI:	10.1016/j.heliyon.2021.e06722
Abstrakt:	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 1 st January 2016 and 31 st 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. A total 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. Competing Interests: The authors declare no conflict of interest. (© 2021 The Author(s).)
Databáze:	MEDLINE
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