High yield criteria for emergency cranial computed tomography in adult patients with no history of head injury

Abstract

Objectives-A recent American study identified clinical factors which effectively predicted those patients who would have significant findings on cranial computed tomography. It was proposed to apply these criteria in a UK setting and to determine whether modifications could be made to improve their eYciency. Methods-A prospective observational study was conducted over a four month period including all non-trauma adult patients referred from the accident and emergency (A&E) department for urgent cranial computed tomography. Presenting symptoms and signs were analysed for ability to predict clinically significant computed tomography findings, namely: acute infarct, malignancy, acute hydrocephalus, intracranial haemorrhage, or intracranial infection. Results-Sixty two patients were included; 22 (35%) had significant findings on computed tomography. Applying the original criteria (any of: age 60 years or older, focal neurology, headache with nausea or vomiting, altered mental status) to the study population showed that no clinically significant tomograms would have been omitted but only 11% fewer performed. Modifying the criteria by removing "age 60 years or older" and replacing "altered mental status" with a Glasgow coma score <14, still ensured 100% sensitivity and would have resulted in 19% fewer scans being performed. Conclusion-Simple clinical criteria can be usefully applied to patients presenting to an A&E department in this country to target patients most likely to have clinically significant findings on urgent cranial computed tomography. (J Accid Emerg Med 2000;17:15-17)

Clinical Yield of Computed Tomography Brain Scans in Older General Medical Patients

“…Thus, reserving scans in the older population for patients with new focal neurological changes would markedly improve the clinical yield of brain CT scans. These findings reinforce those of previous studies that sought to use clinical criteria to improve the yield of brain CT scans in various populations 22–26,30 . Some physicians may lack confidence in their neurological examinations in older, hospitalized, cognitively impairedpatients, but the results of the current study indicate that brain CT scans should not be used in lieu of a neurological examination.…”

“…17 From these data, the following potential predictors, chosen because they represented risk factors for intracerebral infarct, hemorrhage, or masses or because they have been included in previous studies evaluating the yield of brain CT scanning, were examined. 7,8,10,11,[21][22][23][24][25][26][27] These factors included male sex; nonwhite ethnicity; aged 80 and older; admitted with confusion or mental status change; Confusion Assessment Method-documented delirium 28 on or before the date of the CT scan; history of dementia according to the medical record; highest temperature greater than 101.51F; assistance with more than one activity of daily living; 29 fall, headache, or syncope as admitting diagnosis; any alcohol use reported on baseline interview; and current smoking reported on baseline interview.…”

Prospective evaluation of selected clinical criteria for cranial computed tomography in non‐trauma adult patients

“…We were not able to validate the criteria proposed by Harris et al. 9 in our study population because of an unacceptably high false negative rate of 6.7% and a lower sensitivity rate of 93.3%. In essence, if the Harris criteria were applied to our study population, 28 out of 414 patients who had significant CT findings would not have been included in the selection criteria.…”

“…Following the Rothrock study, Harris et al. 9 applied the Rothrock criteria to a small patient population ( n = 62, over 4 months) in a London ED. Thirty‐five per cent of their patient population had clinically significant CT findings.…”

Factors associated with patient exposure and environmental control during pediatric trauma resuscitation

“…18,19 Severe head injuries were identified through the trauma registry as patients with an Abbreviated Injury Scale (AIS) score of 3 or greater in the head and face category. Logistic regression was used for the binary variable of exposure compliance, while linear regression was used for exposure duration (continuous outcome).…”