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Headaches are a common emergency department (ED) presentation. Evidence demonstrates that computed tomography (CT) imaging varies significantly within and across sites. This study explored CT ordering and variation among headache presentations across Alberta EDs.  Methods:  Administrative health data for Alberta were obtained from the National Ambulatory Care Reporting System (NACRS) for all adult (&amp;gt;17 years) headache (ICD-10-CA: G44, G43, R51) ED visits from 2011-2015. Patients with a primary or secondary diagnosis code of headache were included. Exclusions were: sites without CT scanners, Canadian Triage and Acuity Scale score of 1, patients with trauma or external mechanism of injury (e.g., ICD-10-CA S,T,V,W,X,Y), or enhanced/contrast CTs. NACRS data were linked with Alberta Health Services’ (AHS) diagnostic imaging data. Preliminary analysis on imaging variation at the zone, ED site, and physician level was completed using SAS (v.9.4). Physicians who saw less than an average of 10 headache patients per year were excluded.  Results:  Overall, 98,804 headache presentations were recorded (~20,000/year; 8.5% average annual increase) in 30 EDs. The average proportion of visits receiving CT was 25.1% with an average 6.2% increase per year. CT ordering varied across AHS zones (Variation [V]:23%; range:9.6-32.7%). Site ordering variation was more dramatic (V:45%; range:1.4-46.5%). The greatest variation was observed among physicians (V:84 %; range: 0.0-83.7%) with mean ordering proportion of 28.7%.  Conclusion:  From 2011-2015, headache presentations and CT imaging for these patients in the ED increased. Substantial variation in CT ordering exists at multiple levels in Alberta. Further exploration of CT appropriateness is urgently needed.

LO84: Computed tomography use for headache presentations to emergency departments in Alberta: regional, site and physician level variation