23 Prevalence of Covert Brain Infarction in Patients Undergoing Computed Tomography in the Emergency Department

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Covert brain infarctions (CBI) are focal lesions detected on brain imaging consistent with ischemia, in the absence of a history of overt stroke or neurologic dysfunction. CBIs are associated with increased risk of future stroke and dementia. The frequency of this finding in emergency department (ED) patients is not well known. Stroke prevention interventions may be indicated in these patients, yet it is unclear whether ED patients are routinely alerted to the finding, or whether appropriate treatments are recommended. The goal of this study was to determine the frequency of CBI in patients undergoing computed tomography (CT) in the ED and to determine how often clinicians act on these findings or make patients aware of them. All patients over 50 years of age who underwent a non-contrast enhanced head CT in the ED from January to August 2018 were identified. Patients with a history of stroke, or prior brain imaging with any ischemia, were excluded, as were patients admitted to the hospital. Clinical data, including patient history and presence of CBI, were noted. Medical records were reviewed to determine whether the patients with CBI were informed of the finding, either verbally as documented or in their discharge instructions. Subsequent interventions for CBI patients were noted (neurology consultation or medication adjustment). A total of 832 patients were included in our analysis. The average age was 62 years and 50% were female (Table 1). CBI were present in 11% of patients (n=95). Patients with CBI were older and more likely to have hypertension. Only 9% (n=9) of CBI patients were clearly made aware of the finding. Of the patients with CBI, 27% (n = 26) were already on aspirin and 28% (n=27) on a statin. Of those not on medication, aspirin was added in 2 patients and blood pressure medication was added or adjusted in 2 patients. A statin medication was not started on any patients with CBI. Neurology consult was obtained in 9% (n=9) of patients with CBI, of whom 2 were made aware of the findings. The prevalence of CBI in patients over 50 presenting to the ED who undergo head CT and are subsequently discharged from the ED is 11%. Only 9% of these patients were made aware of the finding, with minimal intervention for stroke prevention at the time of their visit. Interventions targeting this population should be considered.