Role and impact of brain computed tomography in the management of drug overdoses and guideline recommendations.

Abstract

Patients presenting with overdoses commonly receive computed tomography brain (CTB) scans in their assessment. There is no current guideline or validated decision support tool for neuroimaging in overdose patients. We investigated the proportion of overdose patients who received a CTB scan and its impact on management. A single site retrospective study was conducted to analyse drugs and alcohol overdose-related presentations over a 2 year period. Outcome measures were the proportion of patients who received a CTB scan and the proportion of those who had an associated change in management. A decision support tool to guide the indications for CTB in overdose patients was developed based on this. A total of 7521 drugs and alcohol-related presentations were screened, where 4086 were overdoses. This involved 3200 patients. CTB scans were conducted in 519 (12.7%) of presentations. The majority of patients with CTB did not have head injury (n = 325, 62.5%). Of 519 CTB scans, 25 (4.8%) were abnormal of which 20 (3.9%) were associated with a change in management. A decision support tool was devised and tested and provided a relatively high yield where a CTB could be justified. A high proportion of overdose patients received CTB scans. There was only a low yield in terms of management alteration. We propose that clinicians adopt a guided approach using a decision support tool to minimise unnecessary CTB scans.