The Role of Head Computer Tomographic Scans on the Management of MICU Patients With Neurological Dysfunction

Salerno, Daniel; Marik, Paul E.; Daskalakis, Constantine; Kolm, Paul; Leone, Frank T.

doi:10.1177/0885066609344940

Cited by 17 publications

(20 citation statements)

References 18 publications

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“…While this lack of statistically significant associations is partially due to the relatively small sample size of our study, it also suggests that no specific clinical characteristics change the magnitude of risk to a degree that they can easily aid in the decision-making regarding the need for head CTs in critically ill patients, including those who develop AMS. Our inability to identify specific risk factors is consistent with two other studies on this topic which were also unable to find any independent predictors [17, 18]. …”

Section: Discussionsupporting

confidence: 91%

“…Our estimate of 12.1% overall for acute changes on all head CTs is lower than similar studies carried out in alternative clinical settings as well as our initial estimate prior to the study [17, 18]. These data are important for guiding clinicians regarding their pre–test probability of finding an acute change if a head CT is ordered.…”

Section: Discussioncontrasting

confidence: 54%

“…The results of our study are supported by two similar studies that assessed head CT use in medical ICU settings using smaller sample sizes. In 2000, Rafanan et al reported new radiological findings in 21.1% of 230 head CTs performed in their medical ICU [19] and in 2008, Salerno et al found new findings in 31% of 123 head CTs [18]. The rates of positive findings were likely higher because of differing exclusion criteria.…”

Section: Discussionmentioning

confidence: 99%

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Frequency of acute changes found on head computed tomographies in critically ill patients: A retrospective cohort study

Khan¹,

Guerra²,

Khandji³

et al. 2014

Journal of Critical Care

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Purpose The frequency of positive findings on computed tomography (CT) of the head in critically ill patients who develop neurological dysfunction is not known. Materials and Methods Cohort study of head CTs for patients admitted to three Intensive Care Units (ICUs) from 2005–10. We documented the frequency of acute changes for all head CTs, and for the subgroup of patients with altered mental status (AMS). We also examined associations between patient characteristics or medications administered prior to head CT and the odds of an acute change on head CT using multivariate logistic regression. Results During 11,338 ICU admissions, there were 901 eligible head CTs on 706 patients (6% of patients). Among head CTs, 155 (17.2%) assessed concern of new focal deficit, 99 (11.0%) concern for a seizure, 635 (70.5%) AMS. Acute changes were found on 109 (12.1%; 95% CI 10.0–14.2%) of all head CTs, and 30% (22.4–36.9%) of patients with focal deficits, 16.2% (8.8–23.5%) of patients with seizures, but only 7.4% (5.4–9.4%) for patients with AMS. A diagnosis of sepsis was associated with a decreased odds of an acute change on head CT for all head CTs (Odds Ratio (OR) 0.61; 95% CI 0.40–0.95, p=0.028), but was not significantly associated with a decreased risk among the cohort of head CTs for AMS (OR 0.82; 95% CI 0.41–1.62, p=0.55). No other factors were associated with an altered risk of acute change on head CT for all patients in our cohort, or for those with AMS. Conclusions Acute changes on head CTs performed for concern regarding new focal neurological deficit or seizures are frequent compared to those performed for AMS with a non-focal exam. No specific patient characteristics or medications were associated with a large change in the likelihood of finding an acute change for patients with AMS.

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

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Frequency of acute changes found on head computed tomographies in critically ill patients: A retrospective cohort study

Khan¹,

Guerra²,

Khandji³

et al. 2014

Journal of Critical Care

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“…Similar results in medical patients were reported by Rafanan et al and Salerno et al [5,6]. Rafanan reviewed the results of 297 brain CT scans and describes a percentage of 37% of these scans to show acute intracranial abnormalities [5].…”

Section: Discussionsupporting

confidence: 71%

Brain computer tomography in critically ill patients - a prospective cohort study

et al. 2012

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BackgroundBrain computer tomography (brain CT) is an important imaging tool in patients with intracranial disorders. In ICU patients, a brain CT implies an intrahospital transport which has inherent risks. The proceeds and consequences of a brain CT in a critically ill patient should outweigh these risks. The aim of this study was to critically evaluate the diagnostic and therapeutic yield of brain CT in ICU patients.MethodsIn a prospective observational study data were collected during one year on the reasons to request a brain CT, expected abnormalities, abnormalities found by the radiologist and consequences for treatment. An “expected abnormality” was any finding that had been predicted by the physician requesting the brain CT. A brain CT was “diagnostically positive”, if the abnormality found was new or if an already known abnormality was increased. It was “diagnostically negative” if an already known abnormality was unchanged or if an expected abnormality was not found. The treatment consequences of the brain CT, were registered as “treatment as planned”, “treatment changed, not as planned”, “treatment unchanged”.ResultsData of 225 brain CT in 175 patients were analyzed. In 115 (51%) brain CT the abnormalities found were new or increased known abnormalities. 115 (51%) brain CT were found to be diagnostically positive. In the medical group 29 (39%) of brain CT were positive, in the surgical group 86 (57%), p 0.01. After a positive brain CT, in which the expected abnormalities were found, treatment was changed as planned in 33%, and in 19% treatment was changed otherwise than planned.ConclusionsThe results of this study show that the diagnostic and therapeutic yield of brain CT in critically ill patients is moderate. The development of guidelines regarding the decision rules for performing a brain CT in ICU patients is needed.

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“…The yield of neuro-imaging depends upon the underlying admitting diagnosis. In a study of 123 medical ICU patients with ''altered mental status'', new CT findings were present in 26 (21%), including ischemic infarction in 13 (11%), intracerebral hemorrhage in 2 (2%), and tumor in 3 (2%) [35]. Very few studies investigate the utility of MRI in patients with delirium.…”

Section: Evaluation Of Delirium In the Icumentioning

confidence: 99%

Delirium and Sedation in the ICU

Frontera

2011

Neurocrit Care

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Delirium is defined by a fluctuating level of attentiveness and has been associated with increased ICU mortality and poor cognitive outcomes in both general ICU and neurocritical care populations. Sedation use in the ICU can contribute to delirium. Limiting ICU sedation allows for the diagnosis of underlying acute neurological insults associated with delirium and leads to shorter mechanical ventilation time, shorter length of stay, and improved 1 year mortality rates. Identifying the underlying etiology of delirium is critical to developing treatment paradigms.

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The Role of Head Computer Tomographic Scans on the Management of MICU Patients With Neurological Dysfunction

Cited by 17 publications

References 18 publications

Frequency of acute changes found on head computed tomographies in critically ill patients: A retrospective cohort study

Frequency of acute changes found on head computed tomographies in critically ill patients: A retrospective cohort study

Brain computer tomography in critically ill patients - a prospective cohort study

Delirium and Sedation in the ICU

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