Computerized Tomography of the Brain for Elderly Patients Presenting to the Emergency Room with Acute Confusion State in Eastern Nepal

Abstract

Background: Acute confusion is a common reason for presentation of elderly patients to the emergency which may be of neurological or non-neurological origin. Computerized tomography (CT) scans are often routinely ordered to investigate the cause. Objective:To determine the usefulness of CT scan brain in confused elderly patients. Methods:A cross-sectional observational study was conducted in emergency room (ER) of B. P. Koirala Institute of Health Sciences over a period of 6 months in 84 patients above the age of 65 years who had CT scan brain done in view of acute confusion. They were reviewed for symptoms, indications of CT scan and presence of focal neurological deficits (FND).Results: Among patients presenting in confusion and with loss of consciousness or limb weakness, CT scan was abnormal in 90% and 92% cases respectively (p <0.05) whereas those presenting with fever, cough, headache, dizziness, seizure in confusion also had abnormal CT but was statistically not significant (p> 0.05). Out of 84 elderly cases of acute confusion, 52 had FND and the remaining 32 cases were without FND. Among those with FND, 40% and 46% cases had features of ischemic and hemorrhagic stroke respectively. Among the 32 without FND, 66% patients had normal scan and 38% had cerebral atrophy. In patients with Glasgow Coma Scale (GCS) < 9 with FND, 75% had CT scan suggestive of hemorrhagic stroke whereas those with GCS> 13 with FND, 57% and 29% cases had ischemic and hemorrhagic stroke respectively. Conclusion:CT scan brain for confused elderly should be advised for those with focal neurological symptoms and may be suggested in cases of head trauma or alleged history of fall irrespective of GCS and symptomatology.

Stroke patients presenting to the emergency department of a tertiary care hospital

“…Advancing age is the single most significant non-modifiable risk factor for causing both types of strokes. 22 The mean age in our study population was 65y. A similar study published Journal of Patan Academy of Health Sciences.…”

Stroke epidemiology and outcomes of stroke patients in Nepal: a systematic review and meta-analysis

“…Thirty-four studies reported the mean age of the patient population [ 10 , 12 – 14 , 19 – 23 , 26 – 28 , 30 , 31 , 33 , 36 – 41 , 45 , 48 , 50 – 53 , 56 , 57 , 59 , 60 , 62 – 64 ]. As indicated in Table 1 , the pooled mean age was 62.4 years, ranging from 51.9 [ 38 ] to 70.5 years [ 18 ]. From 46 studies reporting data on sex distribution, 44 studies showed a higher percentage of stroke in males [ 10 , 12 – 14 , 16 , 19 – 21 , 23 – 28 , 30 – 33 , 35 – 41 , 43 – 45 , 47 – 51 , 53 – 59 , 61 – 64 ] (Table 1 ).…”

“…All 55 studies were hospital-based and were conducted in the tertiary health sector. Of the 55 studies in stroke patients, majority (n = 26) were done in Kathmandu valley [ 12 , 13 , 15 , 16 , 19 , 22 , 27 – 29 , 31 , 33 , 34 , 41 – 45 , 49 – 52 , 54 , 55 , 59 , 61 , 64 ], followed by Sunsari (n = 7) [ 18 , 30 , 40 , 53 , 56 , 60 , 63 ], Chitwan (n = 6) [ 21 , 25 , 26 , 47 , 48 , 57 ] and Morang (n = 6) [ 24 , 32 , 36 , 46 , 58 , 62 ], which represent Central and Eastern region of Nepal. Only three studies were done in Nepalgunj, the Mid-western part of Nepal [ 11 , 23 , 39 ].…”

“…The details of the outcome parameters are presented in Table 2 under the main focus area. Fifty studies reported on the types of strokes [ 10 – 62 , 64 ], and 44 studies investigated risk factors in stroke patients [ 10 , 12 – 14 , 16 , 18 – 26 , 28 , 30 – 33 , 35 – 37 , 39 – 41 , 43 – 45 , 47 – 54 , 56 – 59 , 61 – 64 ]. Six studies described using CT scan [ 10 , 11 , 18 , 28 , 47 , 53 ].…”

“…Fifty studies reported on the types of strokes [ 10 – 62 , 64 ], and 44 studies investigated risk factors in stroke patients [ 10 , 12 – 14 , 16 , 18 – 26 , 28 , 30 – 33 , 35 – 37 , 39 – 41 , 43 – 45 , 47 – 54 , 56 – 59 , 61 – 64 ]. Six studies described using CT scan [ 10 , 11 , 18 , 28 , 47 , 53 ]. Three studies described the use of carotid Doppler in ischemic stroke [ 58 – 60 ].…”