The Yield of Head CT in Syncope: A Pilot Study

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The Yield of Head CT in Syncope: A Pilot Study

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dc.contributor.author Bar, J. L.
dc.contributor.author Mottley, L.
dc.contributor.author Grossman, Shamai Aaron
dc.contributor.author Fischer, Christopher M
dc.contributor.author Lipsitz, Lewis Arnold
dc.contributor.author Sands, Kenneth Eliot Frederick
dc.contributor.author Thompson, Sylvia V
dc.contributor.author Shapiro, Nathan Ivan
dc.contributor.author Zimetbaum, Peter J.
dc.contributor.author Thompson, Sally Wright
dc.date.accessioned 2012-02-28T16:26:58Z
dc.date.issued 2007
dc.identifier.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. en_US
dc.identifier.issn 1828-0447 en_US
dc.identifier.uri http://nrs.harvard.edu/urn-3:HUL.InstRepos:8268111
dc.description.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. en_US
dc.language.iso en_US en_US
dc.publisher Springer-Verlag en_US
dc.relation.isversionof doi://10.1007/s11739-007-0010-5 en_US
dc.relation.hasversion http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780634/pdf/ en_US
dash.license LAA
dc.subject CT en_US
dc.subject head en_US
dc.subject syncope en_US
dc.title The Yield of Head CT in Syncope: A Pilot Study en_US
dc.type Journal Article en_US
dc.description.version Version of Record en_US
dc.relation.journal Internal and Emergency Medicine en_US
dash.depositing.author Grossman, Shamai Aaron
dc.date.available 2012-02-28T16:26:58Z
dash.affiliation.other HMS^Medicine- Beth Israel-Deaconess en_US
dash.affiliation.other HMS^Medicine- Beth Israel-Deaconess en_US
dash.affiliation.other HMS^Medicine- Beth Israel-Deaconess en_US

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