Predictive Value of Noncontrast Head CT with Negative Findings in the Emergency Department Setting

Noncontrast head CTs are routinely acquired for patients with neurologic symptoms in the emergency department setting. Anecdotally, noncontrast head CTs performed in patients with prior negative findings with the same clinical indication are of low diagnostic yield. We hypothesized that the rate of...

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Bibliographic Details
Published in:American journal of neuroradiology : AJNR 2020-02, Vol.41 (2), p.213-218
Main Authors: Callen, A L, Chow, D S, Chen, Y A, Richelle, H R, Pao, J, Bardis, M, Weinberg, B D, Hess, C P, Sugrue, L P
Format: Article
Language:English
Subjects:
Adult
Adult Brain
Aged
Emergency Service, Hospital
Female
Head - diagnostic imaging
Humans
Male
Middle Aged
Predictive Value of Tests
Retrospective Studies
Tomography, X-Ray Computed - methods
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Summary:Noncontrast head CTs are routinely acquired for patients with neurologic symptoms in the emergency department setting. Anecdotally, noncontrast head CTs performed in patients with prior negative findings with the same clinical indication are of low diagnostic yield. We hypothesized that the rate of acute findings in noncontrast head CTs performed in patients with a preceding study with negative findings would be lower compared with patients being imaged for the first time. We retrospectively evaluated patients in the emergency department setting who underwent noncontrast head CTs at our institution during a 4-year period, recording whether the patient had undergone a prior noncontrast head CT, the clinical indication for the examination, and the examination outcome. Positive findings on examinations were defined as those that showed any intracranial abnormality that would necessitate a change in acute management, such as acute hemorrhage, hydrocephalus, herniation, or interval worsening of a prior finding. During the study period, 8160 patients in the emergency department setting underwent a total of 9593 noncontrast head CTs; 88.2% (7198/8160) had a single examination, and 11.8% (962/8160) had at least 1 repeat examination. The baseline positive rate of the "nonrepeat" group was 4.3% (308/7198). The 911 patients in the "repeat" group with negative findings on a baseline/first CT had a total of 1359 repeat noncontrast head CTs during the study period. The rate of positive findings for these repeat examinations was 1.8% (25/1359), significantly lower than the 4.3% baseline rate (
ISSN:0195-6108
1936-959X
DOI:10.3174/ajnr.A6408