PURPOSE: CT is a fast and accurate imaging modality. Not surprisingly it is one of the main diagnostic tools in the emergency department (ER). The purpose of this study was to analyze ER CT findings associated with early in hospital mortality.
METHODS: We retrospectively retrieved all the patients who underwent CT in our tertiary hospital ER during three consecutive years (2012 – 2014). The study cohort included patients with early in hospital mortality, which was defined as mortality in the same day or the following day from presenting to the ER.
Patients’ data was retrieved from the hospital’s computerized medical records and included demographics, CT interpretation and cause of death.
Two radiologists analyzed in consensus the CT interpretations and compared them to the cause of death. CT findings which matched the cause of death were noted. The CT scans were grouped according to organ system (head, abdomen, pulmonary, vascular and musculoskeletal). The relevant top three CT findings for each organ system were noted.
RESULTS: Overall, 1281 patients with early in hospital mortality were retrieved. Of them 227/1281 (17.7%) underwent CT in the ER (Age 75.1±16.1, M:F 117:115). Data was available for 216 patients who comprised the study cohort.
In 127/216 (58.8%) patients CT findings were associated with the cause of death.
The distribution of findings according to organ system was: head 66/127 (51.2%), abdomen 31/127 (24.4%), pulmonary 15/127 (11.8%), cardiovascular 14/127 (11.8%) and musculoskeletal 1/127 (0.7%).
For each organ system the top three findings were:
Head: intracranial hemorrhage 53/66, space occupying lesion 7/66, cerebrovascular infarct 5/66.
Abdomen: intestinal obstruction 8/31, intestinal perforation 6/31, intestinal ischemia 5/31.
Pulmonary: lung consolidation 7/15, pulmonary embolus 4/15, chest contusion 1/15.
Cardiovascular: abdominal aortic aneurysm 7/14, aortic dissection 4/14, sign of cardiac ischemia or failure 3/14.
Musculoskeletal: necrotizing fasciitis 1/1.
DISCUSSION: Intracranial hemorrhage is the commonest CT sign associated with early in hospital mortality. Knowledge of CT signs associated with early in hospital mortality can help in patients’ management and triage.
