Is Cranial CT Effective for Assessing Acute Altered Mental States?

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CT scans are a quick test, but they expose patients to radiation – an average dose is usually 15 mSv in adults, wrote a team led by Dr Roshan Acharya of Virginia Tech Carilion School of Medicine in Roanoke, Va. . Therefore, if its clinical performance for this indication is not significant, it may be best to assess patients in another way.


“[Studies have] suggested that about a third of CT studies could be replaced by alternative approaches or no study at all,” the group noted.


CT scans of the head are the go-to test for evaluating patients who present to the emergency room with an acute atraumatic altered mental state – a condition caused by diseases, disorders or injuries that affect the brain. But even though organizations such as the American College of Radiology (ACR) don’t necessarily recommend ordering it for this indication in the absence of physical trauma, its use is very common, Acharya and colleagues wrote.


The authors sought to investigate the proportion of head examination CT in patients with acutely onset altered mental status and assessed whether the test altered the patient’s clinical management via a literature review of PubMed/Medline, PubMed Central, Embase and CINAHL which consisted of results from 26 studies which included data from 79,201 patients.


The researchers found that the use of CT of the head was high, but its clinical yield was low, with an overall examination rate of 94% but a positive rate of only 11%.


The findings are sobering in light of ongoing efforts to reduce both patient radiation exposure and healthcare costs, the authors said.


“Given the risk of radiation and the added cost of care, clinicians should use CT of the head judiciously,” the team concluded. “Prospective studies involving a larger cohort of patients with acute mental status change are needed to develop clinical risk stratification tools to facilitate the rational use of computed tomography of the head.”

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