Predictors of abnormal brain computed tomography findings in patients with acute altered mental status in the emergency department

Abstract

ObjectiveBrain computed tomography (CT) is commonly performed to diagnose acute altered mental status (AMS), a critically important symptom in many serious diseases. However, negative CT results are common, which result in unnecessary CT use. Therefore, this study aimed to determine the clinical factors associated with positive CT findings.MethodsPatients with acute AMS selected from an emergency department-based registry were retrospectively evaluated. Patients with non-traumatic and noncommunicable diseases on initial presentation and with Glasgow Comal Scale scores of <15 were included in the study.ResultsAmong the 367 brain CT results of patients with AMS during the study period, 146 (39.8%) were positive. In a multivariate analysis, the presence of focal neurologic deficit (odds ratio [OR], 132.6; 95% confidence interval [CI], 37.8 to 464.6), C-reactive protein level <2 mg/dL (OR, 3.9; 95% CI, 1.4 to 10.6), and Glasgow Comal Scale score <9 (OR, 2.4; 95% CI, 1.2 to 4.8) were significantly associated with positive brain CT results.ConclusionThe presence of focal neurologic deficit, initial Glasgow Comal Scale score of <9, and initial C-reactive protein levels of <2 mg/dL can facilitate the selection of brain CT to diagnose patients with acute AMS in the emergency department.

Is brain imaging necessary for febrile elderly patients with altered mental status? A retrospective multicenter study

“…The slight difference could be attributed to differences in enrollment criteria: we included febrile patients down to a slightly lower age (65 years) and also included MRI for detecting ABI. Another study reported that hemorrhage, infarction, and tumor were the most common final diagnoses [14]. Our results are in agreement with that study.…”

“…Shin et al . [ 14 ] concluded that a focal neurological deficit or a GCS < 9 and C-reactive protein < 2 mg/dL are closely related to abnormal findings in brain CT. In line with that study, we found that a lateralizing sign and GCS were predictive factors.…”

“…Brain imaging tests are widely used diagnostic methods for patients who experience mental changes [15]. However, their use raises radiation risk and patient cost [14,16]. In one study, the utilization rate of brain CT increased by 60% over a 7-year period while the number of brain hemorrhage diagnosed stayed constant around approximately 3% [10].…”

“…Lim et al [17] presented seven clinical predictors (age, drowsiness or unresponsiveness, previous cerebrovascular accident or epilepsy, tachycardia, bradycardia, and exposure to drugs) of abnormal CT findings in patients with AMS. Shin et al [14] concluded that a focal neurological deficit or a GCS < 9 and C-reactive protein < 2 mg/dL are…”

Pattern of Emergent Head Computed Tomography Findings in a Tertiary Care Hospital during off Working Hours: Retrospective Analysis

“…Shin et al . [30] in their study found that the presence of focal neurological deficit, C-reactive protein level <2 mg/dl, and Glasgow Coma Scale <9 is associated with positive findings on brain CT in patients with altered sensorium. Our study showed that 69.09% of had no significant findings which was consistent with Shin et al .…”