The Yield of Head CT in Syncope: A Pilot Study

The Yield of Head CT in Syncope: A Pilot Study

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The Yield of Head CT in Syncope: A Pilot Study

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