The Value of Cranial CT Imaging in Patients With Headache at the Emergency Department

Lemmens, Cynthia M C; Linden, Margareta; Jellema, Korné

doi:10.3389/fneur.2021.663353

Cited by 6 publications

(7 citation statements)

References 27 publications

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“…Extra-cranial lesions were detected in more than half of patients compared to intracranial lesions. [8,17,19,[25][26][27] e findings of the present study corroborate with Rai et al [8] who reported a similar pattern of extra-cranial lesions and intracranial lesions. ere was no statistical difference in the proportion of patients diagnosed with sinusitis and brain neoplasm (tumor, metastasis, and cyst) when CT was contrast enhanced.…”

Section: Discussionsupporting

confidence: 92%

Contrast Medium Use in Computed Tomography for Patients Presenting with Headache: 4-year Retrospective Two-Center Study in Central and Western Regions of Ghana

Jimah

Sarkodie

Offei

et al. 2022

Radiology Research and Practice

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Background. Contrast medium (CM) administration during computed tomography (CT) enhances the accuracy in the detection and interpretation of abnormalities. Evidence from literature also validate the essence of CM in imaging studies. CT, by virtue of its ubiquity, ease of use, speed, and lower financial footprint, is usually the first investigation in cases of headache. Through a multicenter retrospective analysis, we compared findings of contrast-enhanced CT (CECT) to noncontrast-enhanced CT (NCECT) head examinations among patients presenting with headache. Methods. A multicenter retrospective analysis of four years’ CT head examination data at two radiology centers located in Central and Western Regions of Ghana were reviewed. Records of patients who presented with headache as principal complaint between January 2017 and December 2020 were reviewed. A total of 477 records of patients with headache were identified, retrieved and evaluated. A Chi-square test and Fisher exact test were used to compare the CECT and NCECT groups. Binary logistic regression analysis was computed to assess association between CECT and each CT findings. Statistical significance was considered at p < 0.05 with a 95% confidence interval. Results. A significant proportion of the patients was females (51.8% in CECT and 60% in NCECT). The NCECT group (40.06 ± 14.76 years) was relatively older than the CECT group (38.43 ± 17.64 years). There was a significant difference between the CECT and NCECT in terms of age ( p = 0.002 ) and facility CT was performed ( p < 0.0001 ). The rate of abnormalities was higher in CECT (43.5%, 166/382) compared NCECT (37.9%, 36/95). There was no significant association between CT head findings and contrast enhancement. Conclusion. CECT examination accounted for 5.6% increase in the detection of head abnormalities. Efforts required to establish local standard operation procedures (SOPs) for contrast medium use especially in CT head examinations. Further studies to improve the knowledge of agents, mechanism of action, and safety of contrast media used among practitioners in Ghana is recommended.

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Section: Discussionsupporting

confidence: 92%

Contrast Medium Use in Computed Tomography for Patients Presenting with Headache: 4-year Retrospective Two-Center Study in Central and Western Regions of Ghana

Jimah

Sarkodie

Offei

et al. 2022

Radiology Research and Practice

View full text Add to dashboard Cite

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“…We found that age > 40 years, smoking, signs/symptoms of infection, and nausea significantly increased the risk of abnormal headache-related findings in MRI, whereas numbness and history of migraine reduced this same risk. Of these factors, older age and nausea were the only ones reported in the previous CT and MRI scores [6,8,9,11]. A focal neurological deficit was reported as a major risk factor in every CT score, but this was not the case in our data.…”

Section: Discussioncontrasting

confidence: 67%

“…Moreover, our data showed various, less common causes that were not met in the previous smaller sample, including Chiari 1 malformation, arterial dissection and occlusion, PRES and signs of intracranial hypotension. When compared to the previous studies using CT for acute headaches, they reported similar prevalences of cerebrovascular conditions (intracranial hemorrhages and ischemia) and newly detected neoplasms, but a lower prevalence of conditions that are more identifiable by MRI (such as infectious diseases and intracranial hypertension) [6][7][8]. We found recent infarcts (identified with DWI) in 30 patients (4% of all, 22% of those with significant findings).…”

Section: Discussionsupporting

confidence: 61%

“…Several clinical risk scores have been developed for nontraumatic headache to reduce unnecessary imaging [6,8,9,11]. In these studies, the most frequently presented predictors of intracranial pathology have been age > 50 years, focal neurological deficit, nausea/vomiting, and altered mental status.…”

Section: Study Highlightsmentioning

confidence: 99%

“…Major neuroimaging findings among outpatients presenting with non-traumatic headache are rare, and concern < 10% of these patients [5]. Studies using computed tomography (CT) have found secondary causes in 13-15% of emergency patients who had undergone cranial CT for headache, which were mostly intracranial hemorrhages or ischemia [6][7][8]. Magnetic resonance imaging (MRI) is a suitable alternative, with superior soft tissue characterization and no ionizing radiation, but only a few studies have investigated its yield in an emergency setting [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic yield of emergency MRI in non-traumatic headache

et al. 2022

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Purpose Non-traumatic headache is one of the most common neurological complaints in emergency departments. A relatively low diagnostic yield of magnetic resonance imaging (MRI) among outpatients has been previously reported, but studies of emergency patients are lacking. We sought to determine the diagnostic yield of emergency MRI among outpatients presenting to the emergency department with non-traumatic headache. Methods In this retrospective cohort study, we analyzed emergency MRI referrals in a tertiary hospital for non-traumatic headache over a five-year period. We recorded patient characteristics, relevant clinical information from the referrals, and imaging outcomes. Results In total, 696 emergency patients with non-traumatic headache underwent MRI, most within 24 h of presentation. Significant findings related to headache were found in 136 (20%) patients, and incidental findings in 22% of patients. In a multivariate model, the predisposing factors of the significant findings were age, smoking, nausea, and signs/symptoms of infection. The protective factors were numbness and history of migraine. A predictive clinical score reached only moderate performance. Conclusion Although emergency MRI shows headache-related findings in one in five patients, accurate prediction modeling remains a challenge, even with statistically significant predictors and a large sample size.

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The impact of headache disorders: a prospective analysis of headache referrals to outpatient and inpatient neurology and emergency services in an Irish University teaching hospital

et al. 2023

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Background Headache represents a significant proportion of disability globally in general practice, neurology outpatient settings, and emergency departments. There is scant literature regarding the impact of headache on healthcare services in Ireland. Aims We aimed to investigate headache burden across the emergency department, inpatient stays, and neurology outpatient department referrals in an Irish University teaching hospital. Methods We prospectively collected data regarding emergency department presentations, inpatient neurology consultations, and neurology outpatient referrals for patients with headache between 13th January and 8th March 2020. Data were analyzed using descriptive statistics. Results There were 180 emergency department attendances, 50 inpatient consultations, and 76 outpatient referrals with headache. Neurological examinations were often incomplete; neuroimaging was commonly employed. Migraine was the most frequent headache diagnosis at discharge in the emergency department and among inpatients after neurology review. Diagnostic uncertainty was identified—33% of patients left the emergency department with no diagnosis, and “unknown/unspecified headache” was recorded on 49% of outpatient referrals and 30% of inpatient consult requests. Medication overuse headache coexisted with migraine in nine patients in the inpatient group. Prophylaxis had been trialed in 56% of patients with migraine referred to outpatients. Conclusions Primary headache disorders have a large impact on hospital services. Diagnostic uncertainty is common; neuroimaging is relied upon. Appropriate care pathways, education, and resource allocation should be prioritized.

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The Value of Cranial CT Imaging in Patients With Headache at the Emergency Department

Cited by 6 publications

References 27 publications

Contrast Medium Use in Computed Tomography for Patients Presenting with Headache: 4-year Retrospective Two-Center Study in Central and Western Regions of Ghana

Contrast Medium Use in Computed Tomography for Patients Presenting with Headache: 4-year Retrospective Two-Center Study in Central and Western Regions of Ghana

Diagnostic yield of emergency MRI in non-traumatic headache

The impact of headache disorders: a prospective analysis of headache referrals to outpatient and inpatient neurology and emergency services in an Irish University teaching hospital

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