Plain CT Head in patients with atraumatic altered mental status has low yield of positive result: JAMA

The Computed Tomography of the Head (CTH) usage in patients with acute-onset atraumatic Altered Mental Status (AMS) was very high but the positive yield was low. The findings were published in the Journal of American Medical Association.

When a patient with acute altered mental status (AMS) is encountered, generally a CT of the head (CTH) is performed as a part of the clinical workup. However, CTH has a relatively low yield in the evaluation of patients with AMS and adds to the cost of care along with radiation exposure. Thus, Roshan Acharya and peers undertook this review to evaluate the usefulness and positive outcome event rate of CTH in AMS patients.

Data (Systematic Reviews and Meta-analyses guidelines) were independently extracted by 2 authors and were pooled using a random-effects method. The PubMed, MEDLINE, PubMed Central, Embase, and CINAHL databases were searched completely using predefined Boolean parameters. All of the studies that met inclusion criteria (Patients with acute AMS, confusion, loss of consciousness, disorientation without evidence of head trauma or focal neurologic deficits while being admitted to the IP or ICU) until January 31, 2022, were included. the review looked for outcomes that included acute ischemic stroke, acute intracranial hemorrhage, intracranial mass, cerebral edema, and new identifiable lesions in the CTH result.

The findings of the extensive review were;

• 26 studies and 25 meta-analysis were qualified out of the 9338 studies identified for the systematic review.
• 25 studies in the meta-analysis included a total of 79 201 patients. The CTH event rate was 94%, and the positive CTH event rate was 11%.
• Random-effects model was used to rule out the significant heterogeneity among the studies included.
• During sensitivity analysis there was no fluctuation of the results detected, this reassured the reliability of the data.

In conclusion, this meta-analysis found that the use of plain CTH in patients with acute-onset atraumatic AMS is high in clinical practice, with a low yield for a positive result. These CT studies are associated with significant radiation exposure as well. "Future mainstream studies are required to provide more reliable estimates for the diagnostic yield of CTH," said the Authors.

Source:

Acharya, R., Kafle, S., Shrestha, D. B., Sedhai, Y. R., Ghimire, M., Khanal, K., Malla, Q. B., Nepal, U., Shrestha, R., & Giri, B. (2022). Use of Computed Tomography of the Head in Patients With Acute Atraumatic Altered Mental Status. In JAMA Network Open (Vol. 5, Issue 11, p. e2242805). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2022.42805