Low Prevalence of Head CT Findings in ED Patients Without Trauma

Fewer than 10% of patients had clinically important findings, but unfortunately, this study's design limits the applicability of its findings.

In a retrospective chart review, researchers assessed the prevalence of clinically important head computed tomography (CT) findings and how often they lead to emergent interventions in emergency department (ED) patients without trauma. During the 1-year study period, 766 adult patients who presented to a single academic ED without trauma and underwent head CT at the discretion of the treating physician (usually a resident) before admission were enrolled.

Clinically significant findings were defined as acute ischemic or hemorrhagic stroke, intracranial hemorrhage, intracranial neoplasm, infection, vascular malformation, obstructive hydrocephalus, or cerebral edema. Emergent therapeutic interventions were defined as any neurosurgical procedure or administration of thrombolytics or anticoagulation for embolic stroke within the first 24 hours after presentation.

Clinically important head CT abnormalities were identified in 8% of patients, and emergent interventions were performed in 1.6%. Eleven of the twelve patients receiving an intervention had focal neurologic findings on examination.

CITATION(S):

Narayanan V et al. Utility of emergency cranial computed tomography in patients without trauma. Acad Emerg Med 2012 Sep; 19:1055.