Clin Exp Emerg Med.  2018 Mar;5(1):1-6. 10.15441/ceem.16.163.

Predictors of abnormal brain computed tomography findings in patients with acute altered mental status in the emergency department

Affiliations
  • 1Department Emergency Medicine, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul, Korea. emdrlee@snu.ac.kr

Abstract


OBJECTIVE
Brain computed tomography (CT) is commonly performed to diagnose acute altered mental status (AMS), a critically important symptom in many serious diseases. However, negative CT results are common, which result in unnecessary CT use. Therefore, this study aimed to determine the clinical factors associated with positive CT findings.
METHODS
Patients with acute AMS selected from an emergency department-based registry were retrospectively evaluated. Patients with non-traumatic and noncommunicable diseases on initial presentation and with Glasgow Comal Scale scores of < 15 were included in the study.
RESULTS
Among the 367 brain CT results of patients with AMS during the study period, 146 (39.8%) were positive. In a multivariate analysis, the presence of focal neurologic deficit (odds ratio [OR], 132.6; 95% confidence interval [CI], 37.8 to 464.6), C-reactive protein level < 2 mg/dL (OR, 3.9; 95% CI, 1.4 to 10.6), and Glasgow Comal Scale score < 9 (OR, 2.4; 95% CI, 1.2 to 4.8) were significantly associated with positive brain CT results.
CONCLUSION
The presence of focal neurologic deficit, initial Glasgow Comal Scale score of < 9, and initial C-reactive protein levels of < 2 mg/dL can facilitate the selection of brain CT to diagnose patients with acute AMS in the emergency department.

Keyword

Unconsciousness; Tomography, X-Ray computed; Diagnosis; Risk factors

MeSH Terms

Brain*
C-Reactive Protein
Diagnosis
Emergencies*
Emergency Service, Hospital*
Humans
Multivariate Analysis
Neurologic Manifestations
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed
Unconsciousness
C-Reactive Protein
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