Diagnostic Decision Patterns in Pediatric Cases with Recurrent Discomfort: Practice Trends Versus Formal Recommendations

Abstract

In routine pediatric care, the application of advanced cranial imaging techniques remains common when addressing ongoing head-related complaints. This study aimed to assess whether current clinical behaviors align with established professional recommendations concerning the use of such diagnostic tools. A retrospective audit was carried out involving children aged 2 to 18 years who were evaluated for recurrent head discomfort at a tertiary pediatric department. The justification for performing brain scans—either magnetic resonance or computed tomography—was documented and assessed against formal clinical protocols.

Out of 215 reviewed cases, 164 individuals (76.3%) underwent imaging. Of these, 93 received MRI scans (56.7%) and 71 underwent CT scans (43.3%). The leading causes for initiating imaging were psychological concerns and/or direct requests from families (71.3%), followed by the presence of features potentially suggesting neurological dysfunction (13.4%), patient age below five years (12.8%), and findings from physical examination pointing to possible abnormalities (2.4%).

Among those imaged, the majority (71.4%) showed no structural anomalies. In the remaining 28.1%, incidental findings were present, but these did not contribute to changes in clinical management. Only one child (0.60%) demonstrated results that led to a direct shift in therapeutic approach. These outcomes suggest that, despite the availability of evidence-based guidance, diagnostic imaging is frequently employed beyond medically justified indications—often with the intent to address anxiety in caregivers and patients rather than to inform treatment decisions.