Head CT Not Always Necessary in ED

Most patients who present to the emergency department (ED) with complaints of syncope or dizziness may not benefit from head CT unless they are older, have a focal neurologic deficit, or have a history of recent head trauma, according to a study published in the American Journal of Roentgenology.

Researchers from the John A. Burns School of Medicine, University of Hawaii and the Kaiser Foundation Hospital, both in Honolulu, Hawaii, undertook a retrospective review study to determine the yield of acutely abnormal findings on head CT scans among patients who presented to the ED with complaints of dizziness, near-syncope, or syncope. They also looked at the clinical factors that potentially predicted acutely abnormal head CT findings and hospital admission.

A total of 489 patients were included in the study. They were seen in the ED between July 1, 2012 and December 31, 2012, and underwent head CT following complaints of dizziness, syncope, or near-syncope. Data collected were:

• Age

• Sex

• Loss of consciousness

• Acute heat trauma

• Seizure

• Headache

• Slurred speech

• Altered mental status

• History of neurologic deficit

• Physical examination findings of a focal neurologic deficit on the ED physicians’ examination

• Use of anticoagulation medications

• Laboratory evidence of drug intoxication or hypoglycemia

• Admission to hospital

• Results of head CT

Data from a three-month follow-up were also collected. The primary outcomes were head CT scans with acutely abnormal findings and hospital admission.

The result showed that 253 patients presented with dizziness (mean age 64.1) and 236 presented with syncope or near-syncope (mean age 65.8). Of the patients with complaints of dizziness, 7.1% were found to have acutely abnormal findings as per the head CT and 18.6% were admitted. Of those with syncope or near-syncope, 6.4% had head CT scans with acutely abnormal findings, and 39.8% were admitted.

The researchers noted that three clinical factors were found to be significantly correlated with acutely abnormal head CT findings: presence of a focal neurologic deficit, being older than 60 years, and history of acute head trauma.

“Our results suggest that most patients presenting with syncope or dizziness to the emergency department may not benefit from head CT unless they are older, have a focal neurologic deficit, or have a history of recent head trauma,” the researchers concluded.