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Utility of multiple rule out CT screening of high-risk atraumatic patients in an emergency department-a feasibility
Mia M Pries-Heje1, Rasmus B Hasselbalch2, Henriette Raaschou3
1CT Innovation Unit, Department of Radiology, Herlev Gentofte Hospital, Herlev, Denmark. miapriesheje@gmail.com.
Insights
Emergency department CT scans for high-risk patients can identify unknown diagnoses and cancers. This screening approach is feasible but requires further study to assess its full clinical impact and radiation risks.
Area of Science:
- Radiology
- Emergency Medicine
- Diagnostic Imaging
Background:
- Previous CT screening trials focused on specific symptoms, not prognosis alone.
- Moderate-to-high risk emergency department (ED) patients may benefit from CT scans despite radiation exposure.
- Prognosis-based CT screening in the ED has not been previously investigated.
Purpose of the Study:
- To evaluate the feasibility and diagnostic yield of accelerated "multiple rule out" CT screening in moderate-to-high risk ED patients.
- To determine if this CT screening strategy can detect clinically unrecognized diagnoses impacting treatment.
- To assess the rate of significant findings, including malignant tumors, in this patient cohort.
Main Methods:
- Inclusion criteria: Patients aged 40 years or older, triaged as high-risk or moderate-to-high risk based on vital signs.
- Imaging protocol: Combined ECG-gated and dual-energy CT scan of the cerebrum, thorax, and abdomen.
- Outcome assessment: Prospective examination of CT scan impact on diagnosis and treatment by an expert panel.
Main Results:
- 100 patients (53% female, mean age 73 years) were included.
- CT scans led to changes in treatment or further examinations in 37% of patients.
- Significant diagnostic findings included 24% of cases, 11% with acute treatment changes, and 10% with previously unrecognized malignant tumors.
- Mean radiation dose was 15.9 mSv.
Conclusions:
- Multi-rule out CT screening in high-risk ED patients is feasible, identifying unrecognized diagnoses and malignancies.
- This approach carries risks of radiation exposure and necessitates further downstream examinations.
- Larger randomized trials are needed to evaluate the clinical impact of these findings.
Background:
Several large trials have evaluated the effect of CT screening based on specific symptoms, with varying outcomes. Screening of patients with CT based on their prognosis alone has not been examined before. For moderate-to-high risk patients presenting in the emergency department (ED), the potential gain from a CT scan might outweigh the risk of radiation exposure. We hypothesized that an accelerated "multiple rule out" CT screening of moderate-to-high risk patients will detect many clinically unrecognized diagnoses that affect change in treatment.
Method:
Patients ≥ 40 years, triaged as high-risk or moderate-to-high risk according to vital signs, were eligible for inclusion. Patients were scanned with a combined ECG-gated and dual energy CT scan of cerebrum, thorax, and abdomen. The impact of the CT scan on patient diagnosis and treatment was examined prospectively by an expert panel.
Results:
A total of 100 patients were included in the study, (53% female, mean age 73 years [age range, 43-93]). The scan lead to change in treatment or additional examinations in 37 (37%) patients, of which 24 (24%) were diagnostically significant, change in acute treatment in 11 (11%) cases and previously unrecognized malignant tumors in 10 (10%) cases. The mean size specific radiation dose was 15.9 mSv (± 3.1 mSv).
Conclusion:
Screening with a multi-rule out CT scan of high-risk patients in an ED is feasible and result in discovery of clinically unrecognized diagnoses and malignant tumors, but at the cost of radiation exposure and downstream examinations. The clinical impact of these findings should be evaluated in a larger randomized cohort.
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