An investigation of factors that influence general practitioners’ referral of computed tomography scans in patients with headache

Abstract

Aim: In assessing patients with headaches, general practitioners (GPs) play animportant role in determining which patients require computed tomography (CT)scans. The purpose of this study was to identify factors that influence GPs’ decisionsto refer CT scans for patients with headaches. Materials and methods: Aself-administered survey was presented to GPs in Western Australia. One hundredand twenty-eight vignettes describing patients who may have required CT referralfor headache were constructed encompassing six clinical variables. Nine vignettes,selected at random, were presented to each respondent. Respondents were askedif they would refer the patient for diagnostic imaging tests, if so, which imagingmodalities would they request, how urgently and the perceived benefits of therequested imaging modality. Multinomial logistic regression was used for the multivariateanalysis. Results: We received 105 completed questionnaires (21%). GPswere more likely to refer patients with headaches for diagnostic imaging and CTscans in the following clinical scenarios: patients with a history of colorectal cancerand epilepsy; and patients feeling unwell for the past 6 weeks and headachebeing exacerbated with valsalva manoeuvrers. Private health insurance and otherrespondent demographics such as GPs experience and site of care increased imagingreferral. Conclusion: GP’s referral decisions of diagnostic imaging and CTexaminations for patients with headaches are dependent on clinical scenarios andthe likelihood of a significant pathology. Further research is required to identifythe significant clinical findings with regard to the CT referrals and ensure that CTscans are not requested in patients who are unlikely to benefit.