Predictors of abnormal brain computed tomography findings in patients with acute altered mental status in the emergency department.
- Author:
Somi SHIN
1
;
Hui Jai LEE
;
Jongwhan SHIN
;
Sejong LEE
Author Information
- Publication Type:Original Article
- Keywords: Unconsciousness; Tomography, X-Ray computed; Diagnosis; Risk factors
- MeSH: Brain*; C-Reactive Protein; Diagnosis; Emergencies*; Emergency Service, Hospital*; Humans; Multivariate Analysis; Neurologic Manifestations; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed; Unconsciousness
- From: Clinical and Experimental Emergency Medicine 2018;5(1):1-6
- CountryRepublic of Korea
- Language:English
- 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.
