The yield of head CT in syncope: a pilot study

Area of Science:

• Emergency Medicine
• Radiology
• Neurology

Background:

• Head computed tomography (CT) is frequently utilized in emergency department (ED) evaluations of syncope.
• The diagnostic yield of routine head CT in this patient population remains under-assessed.

Purpose of the Study:

• To evaluate the effectiveness of routine head CT scans in emergency department patients experiencing syncope.
• To identify factors associated with positive head CT findings in syncope cases.

Main Methods:

• A prospective, observational cohort study was conducted.
• Consecutive adult patients presenting with syncope to an urban tertiary-care ED were enrolled.
• Exclusion criteria included altered mental status, drug-related or trauma-induced loss of consciousness, seizure, or hypoglycemia.

Main Results:

• Of 113 patients who underwent head CT, only 5% (n=5) had abnormal findings (subarachnoid hemorrhage, cerebral hemorrhage, stroke).
• All positive CT findings occurred in patients over 65 years old.
• Targeting head CT to patients with neurological signs/symptoms or on anticoagulation could reduce scans by 56%.

Conclusions:

• Routine head CT in syncope patients has a low diagnostic yield.
• Prospective development of clinical decision rules can significantly decrease unnecessary head CT utilization in the ED.
• This approach can optimize resource allocation and potentially reduce patient exposure to radiation.