The Yield of Head CT in Syncope: A Pilot Study
| Title: | The Yield of Head CT in Syncope: A Pilot Study |
| Author: |
Bar, J. L.; Mottley, L.; Grossman, Shamai Aaron; Fischer, Christopher M; Lipsitz, Lewis Arnold; Sands, Kenneth Eliot Frederick; Thompson, Sylvia V; Shapiro, Nathan Ivan; Zimetbaum, Peter J.; Thompson, Sally Wright
Note: Order does not necessarily reflect citation order of authors. |
| Citation: | Grossman, S. A., C. Fischer, J. L. Bar, L. A. Lipsitz, L. Mottley, K. Sands, S. Thompson, P. Zimetbaum, and N. I. Shapiro. 2007. The yield of head CT in syncope: a pilot study. Internal and Emergency Medicine 2(1): 46-49. |
| Full Text & Related Files: |
2780634.pdf (50.57Kb; PDF) 
|
| Abstract: | Although head CT is often routinely performed in emergency department (ED) patients with syncope, few studies have assessed its value. Objectives: To determine the yield of routine head CT in ED patients with syncope and analyse the factors associated with a positive CT. Methods: Prospective, observational, cohort study of consecutive patients presenting with syncope to an urban tertiary-care ED (48 000 annual visits). Inclusion criteria: age >8 and loss of consciousness (LOC). Exclusion criteria included persistent altered mental status, drug-related or post-trauma LOC, seizure or hypoglycaemia. Primary outcome was abnormal head CT including subarachnoid, subdural or parenchymal haemorrhage, infarction, signs of acute stroke and newly diagnosed brain mass. Results: Of 293 eligible patients, 113 (39%) underwent head CT and comprise the study cohort. Ninety-five patients (84%) were admitted to the hospital. Five patients, 5% (95% CI=0.8%–8%), had an abnormal head CT: 2 subarachnoid haemorrhage, 2 cerebral haemorrhage and 1 stroke. Post hoc examination of patients with an abnormal head CT revealed focal neurologic findings in 2 and a new headache in 1. The remaining 2 patients had no new neurologic findings but physical findings of trauma (head lacerations with periorbital ecchymoses suggestive of orbital fractures). All patients with positive findings on CT were >65 years of age. Of the 108 remaining patients who had head CT, 45 (32%–51%) had signs or symptoms of neurologic disease including headache, trauma above the clavicles or took coumadin. Limiting head CT to this population would potentially reduce scans by 56% (47%–65%). If age >60 were an additional criteria, scans would be reduced by 24% (16%–32%). Of the patients who did not have head CT, none were found to have new neurologic disease during hospitalisation or 30-day follow-up. Conclusions: Our data suggest that the derivation of a prospectively derived decision rule has the potential to decrease the routine use of head CT in patients presenting to the ED with syncope. |
| Published Version: | doi://10.1007/s11739-007-0010-5 |
| Other Sources: | http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780634/pdf/ |
| Terms of Use: | This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA |
| Citable link to this page: | http://nrs.harvard.edu/urn-3:HUL.InstRepos:8268111 |
This item appears in the following Collection(s)
-
HMS Scholarly Articles [4024]
Contact administrator regarding this item (to report mistakes or request changes)
