Headache Assessment of Children for Emergent Intracranial Abnormalities

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Project Summary Annually, over 400,00 children present to emergency departments (EDs) across the U.S. with headaches as their chief complaints. Although a small proportion (0.5-1%) of these children will have brain abnormalities requiring emergent identification, such as tumors, bleeding, or strokes, a much larger proportion undergo neuroimaging of the brain in the ED. Approximately, one-third of children with headaches are receiving unnecessary imaging that increases their exposure to risk associated with neuroimaging. The goal of the Headache Assessment of Children for Emergency Intracranial Abnormalities (HEADACHE) study is to generate definitive evidence that will aid clinicians in determining risk of emergent intracranial abnormality to help identify need for neuroimaging. The primary aim of HEADACHE is to derive and internally validate a decision tool that stratifies the risk for children presenting to EDs with headaches. HEADACHE is a prospective multicenter study planning to enroll 28,000 children 2-17 years old with headaches presenting to one of 18 EDs in the Pediatric Emergency Care Applied Research Network (PECARN). Follow-up for children with headache is essential for providing optimal symptom management and ensuring that necessary diagnostics or consultations are obtained, particularly if neuroimaging is not obtained in the ED. Few data exist, however, to determine whether disparities exist in accessing timely follow-up for children with headaches evaluated in EDs. Timely follow up can include primary care provider (PCP) follow-up, neurology follow-up or outpatient neuroimaging if indicated. This diversity supplement will enhance the HEADACHE study by gaining an in-depth understanding of the barriers and challenges experienced by caregivers of children with headaches when seeking follow-up care for their children after the initial ED visit. The specific aims of this diversity supplement are: (1) to determine whether insurance status and/or race/ethnicity are independently associated with the time to and rate of recommended follow-up to see a PCP or a neurologist, (2) to determine whether insurance status and/or race/ethnicity are independently associated with obtaining neuroimaging and the type of neuroimaging obtained after ED discharge, and (3) to quantitatively and qualitatively explore the caregivers' lived experiences to identify barriers to timely PCP or neurology follow-up among underinsured/publicly insured and/or racial/ethnic minoritized children presenting to the ED with headaches.