Clinical scoring system may improve yield of head CT of non-trauma emergency department patients

Emergency Radiology
Christopher BentMathew Bobinski

Abstract

The positive rate of head CT in non-trauma patients presenting to the emergency department (ED) is low. Currently, indications for imaging are based on the individual experience of the treating physician, which contributes to overutilization and variability in imaging utilization. The goals of this study are to ascertain the predictors of positive head CT in non-trauma patients and demonstrate feasibility of a clinical scoring algorithm to improve yield. We retrospectively reviewed 500 consecutive ED non-trauma patients evaluated with non-contrast head CT after presenting with headache, altered mentation, syncope, dizziness, or focal neurologic deficit. Medical records were assessed for clinical risk factors: focal neurologic deficit, altered mental status, nausea/vomiting, known malignancy, coagulopathy, and age. Data was analyzed using logistic regression and receiver operator characteristic (ROC) curves and three derived algorithms. Positive CTs were found in 51 of 500 patients (10.2 %). Only two clinical factors were significant: focal neurologic deficit (adjusted odds ratio (OR) 20.7; 95 % confidence interval (CI) 9.4-45.7) and age >55 (adjusted OR 3.08; CI 1.44-6.56). Area under the ROC curve for all three algorithms was ...Continue Reading

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Citations

Jul 21, 2016·Emergency Radiology·Emily M FortinCharlene Irvin Babcock
Jul 19, 2017·Journal of Intensive Care Medicine·Fabian FinkelmeierHarald Farnik
Apr 16, 2019·Emergency Medicine Australasia : EMA·Joshua M Scott-KingBetty S Chan
Mar 14, 2018·International Journal of Emergency Medicine·Kerem OzturkMufit Parlak
Jul 19, 2019·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Primož ŽužekSimon Podnar
Feb 23, 2021·International Journal of Clinical Practice·Kevin LombardiAli Pourmand
Nov 28, 2020·Clinical Imaging·Dafna NesselrothEyal Zimlichman
Feb 16, 2019·The American Journal of Emergency Medicine·Wei-Ting WuFu-Jen Cheng
May 8, 2021·Journal of the American College of Radiology : JACR·UNKNOWN Expert Panels on Cardiac Imaging and Neurological ImagingSuhny Abbara
May 28, 2021·Frontiers in Neurology·Cynthia M C LemmensKorné Jellema

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