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Published on: November 13, 2016
Routine Cross-Sectional Head Imaging Before Electroconvulsive Therapy: A Tertiary Center Experience
Payam I Sajedi1, Jason Mitchell1, Edward H Herskovits1
1University of Maryland Medical Center, Baltimore, Maryland.
Purpose:
Electroconvulsive therapy (ECT) is generally contraindicated in patients with intracranial mass lesions or in the presence of increased intracranial pressure. The purpose of this study was to determine the prevalence of incidental abnormalities on routine cross-sectional head imaging, including CT and MRI, that would preclude subsequent ECT.
Methods:
This retrospective study involved a review of the electronic medical records of 105 patients (totaling 108 imaging studies) between April 27, 2007, and March 20, 2015, referred for cranial CT or MRI with the primary indication of pre-ECT evaluation. The probability of occurrence of imaging findings that would preclude ECT was computed. A cost analysis was also performed on the practice of routine pre-ECT imaging.
Results:
Of the 105 patients who presented with the primary indication of ECT clearance (totaling 108 scans), 1 scan (0.93%) revealed findings that precluded ECT. None of the studies demonstrated findings that indicated increased intracranial pressure. A cost analysis revealed that at least $18,662.70 and 521.97 relative value units must be expended to identify one patient with intracranial pathology precluding ECT.
Conclusions:
The findings of this study demonstrate an extremely low prevalence of findings that preclude ECT on routine cross-sectional head imaging. The costs incurred in identifying a potential contraindication are high. The authors suggest that the performance of pre-ECT neuroimaging be driven by the clinical examination.
