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

Abstract

Introduction: Emergency head computed tomography (CT) is rising exponentially during off working hours due to evidence-based medicine, patient’s expectation and desires, easy availability and apprehension of medico-legal cases, thereby raising health-care cost. There is huge gap in demand and supply of radiologist, especially during off working hours. There is need to know the pattern of emergency head findings. Materials and Methods: A retrospective analysis of all emergent noncontrast CT head during off working hours in the Department of Radiodiagnosis of a Tertiary Care Hospital, Mumbai, India, which were performed from June 2017 to May 2018. CT findings of 308 patients were analyzed. Results: About 63.6% of total head CT showed no significant abnormality. The most common abnormality was intracranial hemorrhage which was just 9.1% followed by acute infarct which was 6.2%. Extradural hemorrhage, subdural hemorrhage, and subarachnoid hemorrhage was only 1% each of total head CT findings. No significant abnormality was detected in 74.65%, 70.21%, 89.13%, 31.37%, 100%, and 69.09% in cases of head injury, seizure, giddiness/dizziness/syncope, cerebrovascular accident, transient ischemic attack, and altered sensorium, respectively. Conclusion: Pattern analysis of emergent head CT reveals that most of the emergent CT head shows no significant abnormality. There is a need for stringent guidelines for emergent head CT, training of emergency physician as well as CT technician for common findings to bridge the radiologist demand-supply gap for providing effective health care in peripheral hospitals.

Use of Computed Tomography of the Head in Patients With Acute Atraumatic Altered Mental Status

“…Of 26 studies, 11 were performed in the ED, 5 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 3 in the ICU, 20 , 21 , 22 4 in an inpatient unit, 23 , 24 , 25 , 26 and 8 in mixed settings. 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 Fifteen studies were performed in the US, 5 , 10 , 11 , 18 , 20 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 33 , 34 and 4 in Europe 13 , 16 , 21 , 31 ( Table ).…”

“…The studies were appraised using the Joanna Briggs Institute quality assessment. We rated 11 studies as high quality 12 , 16 , 19 , 22 , 23 , 27 , 28 , 31 , 32 , 33 , 34 and 15 studies as medium quality 5 , 10 , 11 , 13 , 14 , 15 , 17 , 18 , 20 , 21 , 24 , 25 , 26 , 29 , 30 ; none of the studies were rated as low quality (eTables 2-4 in the Supplement ).…”

“…Although all studies included declared the definition of positive CTH findings in the study, only 4 discussed the details of CTH results pertinent to patients with AMS. 15 , 24 , 29 , 34 Four studies mentioned a change in management based on CTH results. 17 , 21 , 24 , 29 The CTH event rates were 92% (proportion, 0.92; 95% CI, 0.61-1.00) in the US and 96% (proportion, 0.96; 95% CI, 0.74-1.00) in Europe (eFigure 1 in the Supplement ).…”

“…Of 26 studies, 11 were performed in the ED, 3 in the ICU, 4 in an inpatient unit, and 8 in mixed settings . Fifteen studies were performed in the US, and 4 in Europe (Table).…”

“…Of 26 studies, 11 were performed in the ED, 5,[10][11][12][13][14][15][16][17][18][19] 3 in the ICU, [20][21][22] 4 in an inpatient unit, [23][24][25][26] and 8 in mixed settings. [27][28][29][30][31][32][33][34] Fifteen studies were performed in the US, 5,10,11,18,20,22,[24][25][26][27][28][29][30]33,34 and 4 in Europe 13,16,21,31 (Table).…”