Brain CT in Patients With Altered Mental Status: Tertiary Care Emergency Department Review

TL;DR

This study examines brain CT scans in emergency patients with altered mental status, finding that nearly a third showed critical issues like bleeding or stroke.

Contribution

The study provides empirical evidence on CT brain scan utility in AMS patients at a tertiary care center.

Findings

29.5% of AMS patients had positive CT brain findings, including intracranial hemorrhage and stroke.

Hypertension and diabetes were the most common comorbidities among AMS patients.

CT positivity was not significantly influenced by the time of imaging.

Abstract

Background

Altered mental status (AMS) is a frequent and non-specific presentation in the Emergency Department (ED), reflecting a wide range of underlying conditions, from benign to life-threatening. Identifying patients who require urgent neuroimaging remains a clinical challenge, as overuse of CT brain scans increases costs and radiation exposure, while underuse may delay critical diagnoses. Despite its prevalence, there is no standardized approach to guide CT utilization in AMS cases, leading to inconsistent practices. This study aims to analyze CT brain findings among AMS patients who received imaging in the ED of King Abdulaziz Medical City, Jeddah, to determine its necessity.

Method

This analytical cross-sectional study was conducted in King Abdulaziz Medical City between January 2023 and December 2023. The sample of the study included all the patients who presented to the ED with AMS and had undergone a CT scan of the brain.

Results

Among 112 AMS patients who underwent CT brain imaging, 29.5% had positive findings, most commonly intracranial hemorrhage (9.8%) and stroke (7.1%). Hypertension (61.6%) and diabetes mellitus (50%) were the most prevalent comorbidities. CT positivity did not differ significantly by time of imaging (p = 0.477).

Conclusion

CT brain was positive in nearly one-third of AMS patients in this study, identifying critical conditions like hemorrhage and stroke. This underscores its necessity in high-risk patients, especially those with multiple comorbidities, focal deficits, trauma, or anticoagulant use. However, the majority of the scans showed no acute findings. We emphasize the future need for prospective studies with control groups and validated risk stratification tools to safely guide CT utilization in AMS patients.