Diagnostic yield and outcomes of computed tomography of the head in critically ill nontrauma patients

Background: Computed tomography of the head (HCT) is a widely used diagnostic tool, especially for emergency and trauma patients. However, the diagnostic yield and outcomes of HCT for patients on medical intensive care u
Background: Computed tomography of the head (HCT) is a widely used diagnostic tool, especially for emergency and trauma patients. However, the diagnostic yield and outcomes of HCT for patients on medical intensive care units (MICUs) are largely unknown.
Methods: We retrospectively evaluated all head CTs from patients admitted to a single-center MICU during a 5-year period for CT indications, diagnostic yield, and therapeutic consequences. Uni- and multivariate analyses for the evaluation of risk factors for positive head CT were conducted.
Results: Six hundred ninety (18.8%) of all patients during a 5-year period underwent HCT; 78.7% had negative CT results, while 21.3% of all patients had at least 1 new pathological finding. The main indication for acquiring CT scan of the head was an altered mental state (AMS) in 23.5%, followed by a new focal neurology in 20.7% and an inadequate wake up after stopping sedation in 14.9% of all patients. The most common new finding was intracerebral bleeding in 6.4%. In 6.7%, the CT scan itself led to a change of therapy of any kind. Admission after resuscitation or a new focal neurology were independent predictors of a positive CT. Psychic alteration and AMS were both independent predictors of a higher chance of a negative head CT. Positive HCT during MICU is an independent predictor of lower survival.
Conclusions: New onset of focal neurologic deficit seems to be a good predictor for a positive CT, while AMS and psychic alterations seem to be very poor predictors. A positive head CT is an independent predictor of death for MICU patients.
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Author:Fabian Finkelmeier, Sophie Walter, Kai-Henrik Peiffer, Anjali Cremer, Andrea Tal, Thomas Vogl, Stefan Zeuzem, Stephan Fichtlscherer, Mireen Friedrich-Rust, Jörg Bojunga, Harald Farnik
URN:urn:nbn:de:hebis:30:3-534274
DOI:http://dx.doi.org/10.1177/0885066617720901
ISSN:1525-1489
ISSN:0885-0666
Parent Title (English):Journal of intensive care medicine
Publisher:SAGE Publications
Place of publication:London [u. a.]
Document Type:Article
Language:English
Year of Completion:2019
Date of first Publication:2017/07/18
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2020/05/01
Tag:CT; computed tomography; critical care unit; critical ill patients; sepsis
Volume:34
Issue:11-12
Pagenumber:12
First Page:955
Last Page:966
Institutes:Medizin
Dewey Decimal Classification:610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (German):License Logo Veröffentlichungsvertrag für Publikationen

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