Emergent Cranial Computed Tomography in the Evaluation of Adult Non‐Trauma Patients in the Emergency Department

Abstract

To study the utilisation pattern of head computed tomography (CT) for non-trauma adult cases in an urban emergency department (ED) and the rate of clinically significant CT abnormalities. We also tried to identify any useful clinical indicators that could be used to predict abnormal scans. Methodology: A one-year case series of adult non-trauma cranial CT scans ordered in an urban ED was studied. Patients less than 16 years old, with CT head done prior to presentation and/or attendance precipitated by trauma were excluded. Logistic regression was used to identify significant predictors for abnormal scans. Clinical indicators that were studied included age, altered mental status (AMS), headache and vomiting, elevated blood pressure, previous history of hypertension, Glasgow Coma Scale (GCS) and presence of focal neurological sign (FNS). Results: 183 adult non-trauma cranial CT scans were included in the study, and 109 (59.6%) CT scans revealed clinically significant abnormalities. Only AMS and FNS were found to be statistically significant in predicting abnormal scans. Patients with AMS had a 2.5 times (95% CI: 1.1 to 5.8) higher odds for an abnormal scan compared to those without AMS, adjusting for FNS. Patients with FNS had adjusted odds of 8.9 (95% CI: 4.2 to 18.8). Conclusion: This study reports a high (59.6%) rate of abnormal adult non-trauma cranial CT compared with previous studies. Altered mental status and the presence of focal neurological sign are significant predictors for an abnormal scan. They should serve as useful criteria when devising utilisation strategies for emergency non-trauma cranial CT in future studies.