Abstract
Background: Head computed tomography (head CT) examinations conducted at emergency departments (EDs) for non-trauma patients are expensive and expose patients to ionizing radiation. Identification of symptoms likely to yield abnormal head CT scans can reduce costs and prevent unnecessary patient irradiation. There is limited comprehensive data in the literature concerning the utilization of head CT in low- and middle-income countries (LMICs) EDs. Methods: A retrospective study of successive non-contrasted head CT scans from February 2017 through January 2018 performed on non-trauma ED patients aged 18 years and above without known pre-existing intracranial pathology was conducted. Univariate and multivariate logistic models were used to determine which presenting clinical features were likely to yield abnormal head CT findings. Clinical information was obtained from the history and physical examination findings entered on the requisition form by the ED clinicians and from previous head CT reports if present on the picture archiving and communication system (PACS). Results: A total of 396 consecutive patients who received head CT examinations had a median age of 49 years (IQR: 36-53), and 53.3% were male (n = 211/396). Of the head CT scans included, 73.5% of head CTs included were abnormal (n = 291/396). Age >61 years (aOR:1.54; 95%CI: 1.12-2.10), focal neurologic deficit (aOR: 2.46; 95%CI: 1.42-4.26), and loss of consciousness (aOR 2.82; 95%CI: 1.21-6.57) were the predictors of abnormal head CT findings. Conclusion: A head CT scan in a non-trauma patient presenting to an emergency department in a low-middle income country like South Africa is likely to yield abnormal findings if a patient presented with age above 61 years, loss of consciousness, or focal neurological deficit.
Highlights
The arrival of computed tomography scan has transformed the investigation of diseases affecting the head [1, 2]
Our sensitivity study showed that there would be a reduction of 31.8% in the number of Head computed tomography (head CT) performed if only patients with the predictors were scanned. This shows the possible cost reduction benefits of implementing a prediction protocol. In this exploratory study of emergency departments (EDs) patients without a history of trauma who underwent head CT, our results showed that patients aged above 61 years, patients with focal neurological deficit (FND), and patients with loss of consciousness (LOC) were likely to have abnormal head CT findings
Our results suggest that head CT based on a lone clinical presentation of non-predicting clinical features may have low yields of abnormal head CT, increases the costs on patients and the health care system, and exposes the patients to unnecessary ionizing radiation increasing the risks of cancer development
Summary
The arrival of computed tomography scan has transformed the investigation of diseases affecting the head [1, 2]. The increase in the number of head CTs performed in nontrauma patients in EDs has led to multiple public health problems such as the rising costs on the part of the patients and health care systems, increased exposure to ionizing radiation, and incidental findings, some of which may require further imaging or create unnecessary healthcare visits or even procedures. The possible carcinogenic effects from ionizing radiation and the rising costs of the increasing number of head CTs in the ED are a concern for policymakers and researchers alike [9]. Head computed tomography (head CT) examinations conducted at emergency departments (EDs) for non-trauma patients are expensive and expose patients to ionizing radiation. There is limited comprehensive data in the literature concerning the utilization of head CT in low- and middle-income countries (LMICs) EDs
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