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What is the role of CT in elderly and confused.

With consideration for those with falls but no head injury.

Diagnostic yield of cerebral imaging in patients with acute confusion 1

Method:

  • Retrospective admissions of acute confusion to DGH in Germany from 2008 to 2011
  • n=294, n=178 had cerebral imaging. Positive yield = 0.14.

Findings:

  1. Patient with dementia and no focal signs = 0.98 are -ve.
    1. Patient with dementia, no focal signs and not drowsy = 1.0 negative
    2. Patient with dementia, no focal signs and fever or dehydration = Pr(1.0) negative.
  2. All patients with no focal signs and fever or dehydration = Pr(1.0) for negative.
  3. Single best negative predictor is Lack of focal signs.

Development of a risk score to guide brain imaging in older patients admitted with falls and confusion 2

Method:

  • Derived 12 predictor parameters from literature and applied to 66 consecutive patients admitted with Falls and Confusion and who had brain imaging to Teaching Hospital in Scotland.
  • Correlation of each risk factor; then final risk score derived.

Findings:

  1. 20% of imaging had new path: acute ICH, Stroke, Mass.
  2. Found that
    1. Previous history of falls
    2. AF
    3. Head or Face trauma
    4. Focal neuro
    5. Warfarin
    6. GCS < 14

All predicted new path. (All +1 except Focal neuro +3)
Whilst antecedent Dementia predicted negative = -1
If cut off was 3 points then S/S = .83/.89 with PPV/NPV of .63/.96.

Comment Aim to optimise the performance data but that is not the point with a screen

  1. Hufschmidt A, Shabarin V. Diagnostic yield of cerebral imaging in patients with acute confusion. Acta Neurol Scand. 2008;118(4):245-250. doi:10.1111/j.1600-0404.2008.01006.x ↩

  2. Brown AJ, Witham MD, George J. Development of a risk score to guide brain imaging in older patients admitted with falls and confusion. Br J Radiol. 2011;84(1004):756-757. doi:10.1259/bjr/78864604 ↩