Referral Indications as Predictors of Acute Findings in CT Scans Performed in the Emergency Room

Evgeni Druskin 1 Dafna Nesselroth 3 Eyal Klang 1 Shelly Soffer 3 Yiftah Barash 3 Chen Hoffman 1 Eli Konen 1 Eyal Zimlichman 2
1Department of Radiology, The Chaim Sheba Medical Center
2Hospital Management, The Chaim Sheba Medical Center
3Sackler Faculty of Medicine, Tel Aviv University

PUPOSE: Head CT is the most common CT scan conducted in the emergency room (ER).

The aim of this study was to evaluate referral indications as predictors of acute findings in CT scans performed in the ER.

METHODS: Institutional review board (IRB) approval was granted for this study. Informed consent was waived by the IRB committee.

The records of one tertiary care hospital`s ER were retrospectively reviewed for consecutive adult patients (≥18 years of age) who underwent a head CT scan, during a time frame of 40 days from January 1st 2017. CT interpretations were obtained and checked for demographics, referral indications and CT findings.

Referral indications were classified into the following groups: head ache, head trauma, dizziness/vertigo, neurological signs, confusion, syncope, seizure, suspected space occupying lesion (SOL), suspected brain infract, suspected brain hemorrhage or other indication. In cases of more than one referral indication, all the indications were noted separately.

CT interpretations were divided into acute and non-acute. Acute interpretation were defined as findings requiring treatment or follow-up, such as: brain hemorrhage, acute infarct, a new SOL , face or skull fractures, sinusitis and new hydrocephalus.

Associations between referral indications and the presence of acute findings were calculated.

RESULTS: During the study`s time frame, 12,958 adult patients presented to our ED, 1,534 of them underwent a head CT (11.9%). 2,122 indications were noted for the entire cohort. Acute findings were observed in 238 of the 1,534 patients (15.6%).

The frequencies of acute findings for each indications were: seizure 22/86 (26%), confusion 23/118 (19%), other indication 23/121 (19%), syncope 24/137 (18%), neurological signs 74/494 (15%), head trauma 65/497 (13%), head ache 36/307 (12%), dizziness 14/178 (8%), suspected SOL 5/61 (8%), suspected brain hemorrhage 3/111 (3%) and suspected brain infract 2/83 (2%).

CONCLUSION: Acute findings were found in 15% of the head CT scans performed in the ER. The indication of seizure showed the highest association with acute findings.

Indications associated with objective signs or symptoms such as seizures or confusion showed higher association with acute findings in comparison to indications stating a subjective suspicion of brain infarct or hemorrhage.