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Intern Emerg Med. 2007 Mar;2(1):46-9. Epub 2007 Mar 31.

The yield of head CT in syncope: a pilot study.

Author information

1
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, WCC2, One Deaconess Road, Boston, MA 02115, USA. sgrossma@caregroup.harvard.edu

Abstract

Although head CT is often routinely performed in emergency department (ED) patients with syncope, few studies have assessed its value.

OBJECTIVES:

To determine the yield of routine head CT in ED patients with syncope and analyse the factors associated with a positive CT.

METHODS:

Prospective, observational, cohort study of consecutive patients presenting with syncope to an urban tertiary-care ED (48,000 annual visits).

INCLUSION CRITERIA:

age >or=18 and loss of consciousness (LOC). Exclusion criteria included persistent altered mental status, drug-related or post-trauma LOC, seizure or hypoglycaemia. Primary outcome was abnormal head CT including subarachnoid, subdural or parenchymal haemorrhage, infarction, signs of acute stroke and newly diagnosed brain mass.

RESULTS:

Of 293 eligible patients, 113 (39%) underwent head CT and comprise the study cohort. Ninety-five patients (84%) were admitted to the hospital. Five patients, 5% (95% CI=0.8%-8%), had an abnormal head CT: 2 subarachnoid haemorrhage, 2 cerebral haemorrhage and 1 stroke. Post hoc examination of patients with an abnormal head CT revealed focal neurologic findings in 2 and a new headache in 1. The remaining 2 patients had no new neurologic findings but physical findings of trauma (head lacerations with periorbital ecchymoses suggestive of orbital fractures). All patients with positive findings on CT were >65 years of age. Of the 108 remaining patients who had head CT, 45 (32%-51%) had signs or symptoms of neurologic disease including headache, trauma above the clavicles or took coumadin. Limiting head CT to this population would potentially reduce scans by 56% (47%-65%). If age >60 were an additional criteria, scans would be reduced by 24% (16%-32%). Of the patients who did not have head CT, none were found to have new neurologic disease during hospitalisation or 30-day follow-up.

CONCLUSIONS:

Our data suggest that the derivation of a prospectively derived decision rule has the potential to decrease the routine use of head CT in patients presenting to the ED with syncope.

PMID:
17551685
PMCID:
PMC2780634
DOI:
10.1007/s11739-007-0010-5
[Indexed for MEDLINE]
Free PMC Article
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