Background: In developing sub-Saharan Africa countries such as Cameroon, the head CT-scan, which is more available and accessible than magnetic resonance imaging, gold standard, exposes to a high irradiation dose level and is still expensive. In those countries, head CT-scan has become a routine exploration in patients with headache. In front of this inflation, it is necessary to assess CT-scan requests and their profitability in the patient management.
Objective: To assess the relevance and the usefulness of head computerized tomography scanner (CT-scan) requests in the management of adult headache in two referral teaching hospitals of Cameroon, in order to improve their appropriateness.
Methods: This was a prospective cross-sectional study conducted in medical imaging units of the Central Hospital of Yaounde and the Laquintinie Hospital of Douala on five months period. We confronted indication mentioned on head CT-scan requests to the recommendation grades and indication’s mentions of the referral imaging guidelines of the French Society of Radiology in order to assess the relevance on the one hand. We also confronted head CT-scan results to the expectations of the requesting physicians in order to assess the usefulness on the other hand.
Data analysis: Non-parametric statistical analysis.
Results: During the study period, 169 examinations requests for headaches were collected. Symptom was the main clinical data mentioned on CT-scan requests (60.4%), followed by the suspected clinical diagnosis (40.2%). Requesting physicians were general practitioners (50.3%), followed by neurologists in 14.2%. Overall, 92.3% of requests were judged appropriate while 2.4% were non-indicated. The general practitioner’s requests were non-indicated in 75% of the cases. Inappropriate requests multiplied by two the risk of having no significant abnormality on the head CT-scan. Of all the head CT-scan requests, 73.2% were useful and 100% of relevant CT-scans were also useful. 45.5% of useless head CT-scans were requested by a general practitioner.
Conclusion: Physicians need to follow the guidelines and justify the use of head CT-scans in patients suffering from headache in order to improve the relevance and usefulness of head CT-scans requests.