CT question

[pedspnp]

Can someone answer a question for me. But first the scenario. Pt seen by primary dx sinusitis after c/o of headache fever purulent nasal discharge. Primary orders ct of head. Shows sinus mucosal thickening primary starts sugmentin. I see pt 2 weeks later still c/o of headache. Pt has glasses not wearing them because I kid you not had thrown up on them 10 days prior and mom had not cleaned them for her. Headaches are frontal, worse at end of school day. I recommend that she start wearing glasses as prescribed and to keep a headache diary. Pt follows up with primary today, she is now wearing glasses has no headache. Primary comes to me after visit wanting to know why I did not order another ct on pt when I saw her. Told me he was ordering a second ct and sending her to neurology. So I guess my question is does 2 ct scans 2 weeks apart sound reasonable. I think it is a little over the top, considering that her sx are now resolved. She has had headaches in the past and a hx of not wearing glasses. Thanks

[lowrylb]

I think what you ordered is very reasonable. Her symptoms are relieved after the dx of sinusitis. Why a CT was actually ordered at that time I'm not sure, CT scans are not usually indicated. I would think with a hx of headaches a CT would not be warranted. No red flags seem present by your description so I would as you did recommend wearing glasses (major factor of headache causes) and write a headache diary. I don't think the 2nd CT isn't indicated at this time. Based on this information I don't think you did a thing wrong

[pedspnp]

Thanks this same doctor orders abx 3 months in advance in case the child gets sick so last week I had a hard time explaining why a strep test would be useless on a child on amox who actually had influenza and since I was off when he came back pos for influenza he put him on tamiflu 7 days after being sypmtomatic