Cranial CT scans-emergency department utilization

doi:10.1016/0736-4679(93)90325-2

The Journal of Emergency Medicine

Volume 11, Issue 5, September–October 1993, Pages 643-646

https://doi.org/10.1016/0736-4679(93)90325-2 Get rights and content

Abstract

The purpose of this retrospective review was to determine high-yield criteria for the ordering of cranial computed tomography (CT scans) in the emergency department. All patients (n = 416) presenting to an adult tertiary care Emergency Department over a 1-year period who required an emergency CT scan were studied. The indications for the scan and the rate of abnormal results were headache (26%), seizures (17%), focal weakness (46%), acute trauma (37%), late trauma (22%), altered mental status (32%), coma (54%), and other (32%). The overall rate of abnormal scans was 39%. In conclusion, the current clinical practice of ordering cranial CT scans on an emergency basis seems to produce an acceptable level of “abnormal” results. Additional prospective studies are required to further define high-yield criteria and measure the impact of the “negative” scan on patient management.

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Citation Excerpt :
The meta-analyses were performed with the software STATA (version 13, StataCorp, College Station, TX, USA). A total of 41 studies [22–62] enrolling 15,760 patients were included in this review (Fig. 1). The inter-rater agreement for study selection was 99.1% (κ = 0.63).
To determine if pooled estimates of the prevalence of unexpected findings in patients with headache and normal neurologic examination support current expert opinion-based neuroimaging guidelines.
We searched PubMed and EMBASE for studies reporting neuroimaging findings in patients with headache and normal neurologic examination up to September 30, 2017. The overall and disease-specific prevalence of unexpected findings were pooled through random-effects meta-analysis. This study is registered with PROSPERO, registration number CRD42017079714.
In forty-one studies including 15,760 participants, the overall prevalence of unexpected findings and normal variants was 17.5% (95% CI: 13.1–22.3). The prevalence was 26.6% (95% CI: 15.5–39.4) in studies using MRI only. The prevalence of vascular, neoplastic, and non-neoplastic findings was 6.6%, 1.4%, and 9.6%. The pooled disease-specific prevalence was 2.0% for stroke, 1.8% for aneurysms, 0.8% for subdural hematoma, 0.7% for hydrocephalus, 0.2% for glioma, and 0.1% for meningioma. In secondary analysis, there was 0.4% increase in the prevalence of vascular unexpected findings with each 1% increase in the proportion of migraine with aura (p-value for meta-regression = 0.005).
In patients with headache and normal neurologic examination, important vascular and neoplastic unexpected findings are rare and better detected with MRI. This supports current American College of Radiology and European Headache Federation recommendations to avoid systematic imaging in such patients and prefer MRI when imaging is needed.
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View full text

Cranial CT scans-emergency department utilization

Abstract

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Hospital cost containment in the 1980's—hard lessons learned and prospects for the 1990's

N EnglJ Med

Recognition of subarachnoid hemorrhage

Ann Emerg Med