Primary care access to computed tomography for chronic headache.

ABSTRACT

BACKGROUND: The diagnostic yield of neuroimaging in chronic headache is low, but can reduce the use of health services. AIM: To determine whether primary care access to brain computed tomography (CT) referral for chronic headache reduces referral to secondary care. DESIGN OF STUDY Prospective observational analysis of GP referrals to an open access CT brain scanning service. SETTING: Primary care, and outpatient radiology and neurology departments. METHOD: GPs in Tayside and North East Fife, Scotland were given access to brain CT for patients with chronic headache. All referrals were analysed prospectively over 1 year, and questionnaires were sent to referrers to establish whether imaging had resulted in or stopped a referral to secondary care. The Tayside outpatient clinic database identified scanned patients referred to the neurology clinic for headache from the start of the study period to at least 1 year after their scan. RESULTS: There were 232 referrals (55.1/100 000/year, 95% confidence interval = 50.4 to 59.9) from GPs in 59 (82%) of 72 primary care practices. CT was performed on 215 patients. Significant abnormalities were noted in 3 (1.4%) patients; there were 22 (10.2%) non-significant findings, and 190 (88.4%) normal scans. Questionnaires of the referring GPs reported that 167 (88%) scans stopped a referral to secondary care. GPs referred 30 (14%) scanned patients to a neurologist because of headache. It is estimated that imaging reduced referrals to secondary care by 86% in the follow-up period. CONCLUSION: An open access brain CT service for patients with chronic headache was used by most GP practices in Tayside, and reduced the number of referrals to secondary care.