Clinical yield of computed tomography brain scans in older general medical patients.

摘要: OBJECTIVES: To evaluate the clinical yield of computed tomography (CT) brain scans in a prospective cohort older patients admitted to general medicine service. DESIGN: Nested study 117 subjects enrolled previous 919 subjects. SETTING: University-affiliated teaching hospital. PARTICIPANTS: Hospitalized medical aged 70 and who received one or more CT during their hospital stay. MEASUREMENTS: Review records interpretation first scan these for indications ordering clinically significant abnormalities. Medical with abnormalities were reviewed 2 weeks after changes management resulting from findings. Three independent reviewers adjudicated presence treatment changes. RESULTS: Of scans, 32 (27%) ordered exclude intracranial hemorrhage, 30 (26%) cerebrovascular accident (CVA), 16 (14%) falls, 15 (13%) syncope, seven (6%) subdural five (4%) mental status change, 12 (10%) other reasons. 29 (25%) had abnormalities, including acute CVA old CVA, meningioma, Only 10 (9% all 34% abnormal scans) resulted (including consultations, further imaging, stroke evaluation, drug changes). The focal neurological deficits was significantly associated (odds ratio=13.2, 95% confidence interval=1.7–161.5). CONCLUSION: These results suggest that overall unselected hospitalized is low. Targeting toward new will help improve yield.