Rationale for issuing neuroimaging requests for patients with primary headaches: a cross-sectional survey of hospitals and clinicians in China

Abstract

Abstract Background Neuroimaging is overused globally in patients with primary headaches. Evidence of this is lacking in China. We aimed to investigate the prevalence of neuroimaging in patients with primary headaches and the clinician-based rationale for requesting neuroimaging in China. Methods This was a cross-sectional survey of hospitals and clinicians in China. We used a convenience sampling method to recruit patients with primary headaches admitted to six hospitals in three provincial capitals in 2022. We identified whether neuroimaging had been requested and the types of neuroimaging conducted. We interviewed clinicians using a combination of personal in-depth and topic selection group interviews to explore why doctors request neuroimaging. Results Among 2,263 patients recruited for this study, 1,942 (89.75%) underwent neuroimaging. Patients underwent head computed tomography (CT), 628 (27.75%); magnetic resonance imaging (MRI), 1,157 (51.13%); or both CT and MRI, 246 (10.87%). Fifteen of the 16 interviewed clinicians would not issue a neuroimaging request for patients with primary headaches. Further, we found that doctors issued a neuroimaging request for patients with primary headaches mostly to exclude the risk of misdiagnosis, reduce uncertainty, avoid medical disputes, meet patients’ medical needs, and complete the hospital assessment indicators. Conclusions For primary headaches, the probability of clinicians requesting neuroimaging is higher in China than in other countries. There is considerable room for improvement in finding appropriate strategies for doctors and patients to reduce the use of low-value care.